Case Report: Indirect Traumatic Optic Neuropathy from Subconcussive Soccer Headers in a 62-year-old Athlete.

SIGNIFICANCE: Traumatic optic neuropathy is an uncommon but devastating cause of vision loss after injury to the head. Soccer players may have a heightened risk because of the game's emphasis on heading the ball, a technique in which a player hits the soccer ball with his/her head. PURPOSE: This article reviews the case of an avid soccer player with traumatic optic neuropathy that occurred after numerous soccer ball headings during a game. This article also (1) provides a summary of the pathophysiology and epidemiology of traumatic optic neuropathy, (2) reviews the current literature on head and eye injuries in soccer, and (3) discusses biomechanical differences in orbital structure throughout aging, which may predispose older patients to traumatic optic neuropathy. CASE REPORT: We present the case of a 62-year-old male patient who reported to the clinic, after repeated subconcussive soccer ball headers the previous day, with symptoms of blurred vision and "seeing stars" in the right eye and a right inferior visual field impairment. Physical examination, subsequent laboratory work, and neurologic consults implicated traumatic optic neuropathy as the primary diagnosis, and halting soccer playing resulted in symptom improvement. CONCLUSIONS: Although not commonly encountered in soccer players, the potential for traumatic optic neuropathy exists. Older athletes may be predisposed because of morphological changes of the orbit. Future direction may look to further investigate hazards promoting traumatic optic neuropathy in older athletes and determine possible protections against injury.

Matrix metalloproteinase and its drug targets therapy in solid and hematological malignancies: an overview.

Matrix metalloproteinase (MMP) comprises a family of zinc-dependent endopeptidases that degrade various components of the extracellular matrix (ECM) and basement membrane. MMPs are involved in solid and hematological malignancy through modification of cell growth, activation of cancer cells and modulation of immune functions. Several polymorphisms of different MMPs such as MMP-1 (-1607 1G/2G), MMP-2 (-1306 C/T), MMP-3 (-1171 5A/6A) & MMP-9 (-1562 C/T) and their expression levels have been well documented in different types of solid cancer. These polymorphic variations were found to be associated with angiogenesis, cancer progression, invasion and metastasis. There is paucity of data available in the field of hematological malignancies. Hence the field of matrix biology of hematological malignancies is an area of active exploration. A number of MMP inhibitors (MMPIs) have been developed for the cancer treatment. The most extensively studied classes of MMP inhibitors include Batimastat, Marismastat, Salimatat, Prinomastat and Tanomastat. However, their efficacy and action have not been confirmed and more data is required. The application of one or more selective targeted MMPIs in combination with conventional anti-leukemic treatment may represent a positive approach in combat against hematopoietic malignancies. Balance of MMPs and TIMPs is altered in different malignancies and biochemical pathways. These alternations will add another dimension in the matrix biology of both solid tumor and leukemia. MMP and TIMP singly and in combination are increasingly being recognized as an important player in basic cellular biology. Exploration and exploitation of MMP and TIMP balance in various malignant and nonmalignant lesions is going to be one of the most interesting facets of future use of this system for human health care.

Role of functional polymorphism of matrix metalloproteinase-2 (-1306 C/T and -168 G/T) and MMP-9 (-1562 C/T) promoter in oral submucous fibrosis and head and neck squamous cell carcinoma in an Indian population.

The aim of this study was to explore the association of MMP-2 (-1306 C/T and -168 G/T) and MMP-9 (-1562 C/T) promoter polymorphisms in oral submucous fibrosis (OSMF) and head and neck squamous cell carcinoma (HNSCC) cases. These SNP were genotyped by PCR-RFLP. Total of 1260 individuals were recruited, of which 412 OSMF, 422 HNSCC and 426 were controls. In HNSCC, MMP-2 (-1306 C/T) and MMP-9 (-1562C/T) polymorphism, T allele showed strong association (p < 0.00 and p < 0.01) as compared to healthy control respectively, but not in case of OSMF and showed significant association with increasing progression of clinico-pathological grading. We concluded that SNPs in the MMP-2 and -9 promoter region may be associated with susceptibility to HNSCC not in OSMF.

Tobacco use by Indian medical students and the need for comprehensive intervention strategies.

BACKGROUND: Tobacco is one of the most important causes of pulmonary and cardiac diseases. Health professionals, including medical students, should ideally play an important role in the fight against tobacco use but several reports suggest that a good number of medical students are themselves addicted to tobacco. METHODS: This is a single institutional cross-sectional survey of preclinical medical students in Moti Lal Nehru Medical College, Allahabad over a five-year period from 2003-2007. Data was collected using the WHO Global Health Professionals Survey questionnaire. RESULTS: 560 students over a period of five years were included in this study. A total of 183 were tobacco users of which 83 were tobacco chewers, 59 cigarette smokers and 41 were addicted to both chewing and smoking. As health professionals, 88% knew that they should advise their patients to quit tobacco. CONCLUSION: This study showed rampant abuse of tobacco. Specific smoking cessation training is needed for medical students to develop appropriate skills and strategies.

Comparative study between the Hybrid Capture II test and PCR based assay for the detection of human papillomavirus DNA in oral submucous fibrosis and oral squamous cell carcinoma.

BACKGROUND: Oral malignancy is a major global health problem. Besides the main risk factors of tobacco, smoking and alcohol, infection by human papillomavirus (HPV) and genetic alterations are likely to play an important role in these lesions. The purpose of this study was to compare the efficacy of HC-II assay and PCR for the detection of specific HPV type (HPV 16 E6) in OSMF and OSCC cases as well as find out the prevalence of the high risk HPV (HR-HPV) in these lesions. METHODS AND MATERIALS: Four hundred and thirty patients of the potentially malignant and malignant oral lesions were taken from the Department of Otorhinolaryngology, Moti Lal Nehru Medical College, Allahabad, India from Sept 2007-March 2010. Of which 208 cases were oral submucous fibrosis (OSMF) and 222 cases were oral squamous cell carcinoma (OSCC). The HC-II assay and PCR were used for the detection of HR-HPV DNA. RESULT: The overall prevalence of HR-HPV 16 E6 DNA positivity was nearly 26% by PCR and 27.4% by the HC-II assay in case of potentially malignant disorder of the oral lesions such as OSMF. However, in case of malignant oral lesions such as OSCC, 32.4% HPV 16 E6 positive by PCR and 31.4% by the HC-II assay. In case of OSMF, the two test gave concordant result for 42 positive samples and 154 negative samples, with an overall level of agreement of 85.4% (Cohen's kappa = 66.83%, 95% CI 0.553-0.783). The sensitivity and specificity of the test were 73.7% and 92.05% (p < 0.00). In case of OSCC, the two test gave concordant result for 61 positive samples and 152 negative samples, with an overall level of agreement of 88.3% (Cohen's kappa = 79.29, 95% CI 0.769-0.939) and the sensitivity and specificity of the test were 87.14% and 92.76% (p < 0.00). CONCLUSION: This study concluded that slight difference was found between the positivity rate of HR-HPV infection detected by the HC-II and PCR assay in OSMF and OSCC cases and the HC II assay seemed to have better sensitivity in case of OSCC.

Functional polymorphism of the MMP-1 promoter (-1607 1G/2G) in potentially malignant and malignant head and neck lesions in an Indian population.

Matrix metalloproteinases (MMP) are a family of zinc-dependent proteases that degrade the entire component of the extracellular matrix. Our study explores the association of the MMP1 gene promoter (-1607 1G/2G) polymorphisms in oral submucous fibrosis (OSMF) and head and neck squamous cell carcinoma (HNSCC) in an Indian population. The MMP1 single-nucleotide polymorphism (SNP) was genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis in 412 patients with OSMF, 422 with HNSCC and 426 controls. Our results showed that the frequency of 1G/2G or 2G/2G promoter genotypes having the 2G allele is associated with higher enzymatic activity and significantly increases in OSMF (p<0.001) and HNSCC cases (p<0.00). In this study, results concluded that SNPs in the MMP1 promoter region may be associated with susceptibility to OSMF as well as HNSCC in an Indian population and addiction habits such as areca nut chewing and alcohol abuse may enhance the expression of the 2G allele of MMP1 genes in OSMF and HNSCC cases.

Morphometric analysis in potentially malignant head and neck lesions: oral submucous fibrosis.

OBJECTIVE: The objective of this study is to analyze cases of oral submucous fibrosis (OSMF) Grade I, II, III and IV morphometrically with regard to epithelium, vasculature and fibrosis and determine any correlation with histological grading after Pindborg and Sirsat. MATERIALS AND METHODS: Eighty three oral submucous fibrosis cases were analyzed morpometrically using an interactive image analysis system in the Department of Pathology, M.L.N Medical College, Allahabad, U.P, India. Paraffin embedded sections of 3-4 microm thickness were stained with hematoxylin/eosin, Van Gieson's picric acid and acid fuchsin stain and Masson's trichrome stains. Image analysis was performed with specific software (Image Pro Plus 6.0) and data obtained were finally transported to Excel sheets for calculation of average values for each parameter. RESULTS: With the grading criteria applied, 9 cases of OSMF were grade I, 32 grade II, 39 grade III and 3 grade IV. Clinical trismus was most frequent in Grade IV followed by Grade III, II and I respectively. OSMF Grade I cases did not show any measurable amount of collagenization, whereas it showed a significant increase with OSMF I and II grades [Pearson's chi2 test= 85.72; p= 0.051] and OSMF-III and IV [Pearson's chi2 test=188.74; p<0.001]. Numbers of endothelial cells per low power field consistently decreased with the increasing grade. CONCLUSIONS: We concluded that mean blood vessel area and the mean vessel diameter showed a marked increase in grade II and a marker decrease in grade IV and the grade III, collagen thickness (mum) increases according to increasing grade while density of endothelial cells decreases.

A cross-sectional study evaluating chemiluminescence and autofluorescence in the detection of clinically innocuous precancerous and cancerous oral lesions.

BACKGROUND: ViziLite Plus with TBlue system (Zila Pharmaceuticals; now Zila, a division of Tolmar, Fort Collins, Colo.) and VELscope (LED Dental, White Rock, British Columbia, Canada) are oral cancer screening aids that have been developed to assist dentists in identifying precancerous and cancerous oral lesions. METHODS: The authors screened patients with an overhead examination light and then with VELscope or ViziLite. Patients with a clinically innocuous lesion underwent a biopsy, and the authors compared the results of tissue pathological analysis with findings from the screening aid tests to determine the sensitivity and specificity of each device. The authors tested these devices to determine their ability to aid in the decision-making process regarding whether further evaluation of a clinically innocuous lesion was required. RESULTS: The authors examined 102 lesions with ViziLite and then biopsied them [corrected]. They found three dysplasias and one malignancy, none of which were detected with the ViziLite (sensitivity = 0 percent, confidence interval [CI] = 0-60.2 percent; specificity = 75.5 percent, CI = 66.7-82.8 percent). The authors examined another 156 lesions with VELscope and then biopsied them [corrected].They found 11 dysplasias and one malignancy, six of which were detected with VELscope (sensitivity = 50 percent, CI = 21.1-78.9 percent; specificity = 38.9 percent, CI = 30.8-46.9 percent). CONCLUSIONS: The study results indicate that use of ViziLite or VELscope along with a conventional screening examination for lesions deemed clinically innocuous was not beneficial in identifying dysplasia or cancer. Additional clinical studies are needed before these devices can be recommended. CLINICAL IMPLICATIONS: Clinicians and patients could have a false sense of security after obtaining a negative ViziLite or VELscope examination result because potentially large numbers of precancerous and cancerous lesions will be missed by both devices.

Prevalence of oral soft tissue lesions in Vidisha.

BACKGROUND: The purpose of this study was to determine the prevalence of oral soft tissue lesions in patients and to assess their clinicopathological attributes. 3030 subjects belonging to a semi-urban district of Vidisha in Central India were screened. Patients were examined with an overhead examination light and those who were identified with a questionable lesion underwent further investigations. Statistical analysis was done using the SPSS software. FINDINGS: 8.4 percent of the population studied had one or more oral lesions, associated with prosthetic use, trauma and tobacco consumption. With reference to the habit of tobacco use, 635(21%) were smokers, 1272(42%) tobacco chewers, 341(11%) smokers and chewers, while 1464(48%) neither smoked nor chewed. 256 patients were found to have significant mucosal lesions. Of these, 216 cases agreed to undergo scalpel biopsy confirmation. 88 had leukoplakia, 21 had oral submucous fibrosis, 9 showed smoker's melanosis, 6 patients had lichen planus, 17 had dysplasia, 2 patients had squamous cell carcinoma while there was 1 patient each with lichenoid reaction, angina bullosa hemorrhagica, allergic stomatitis and nutritional stomatitis. CONCLUSIONS: The findings in this population reveal a high prevalence of oral soft tissue lesions and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals.

Correlation of addictive factors, human papilloma virus infection and histopathology of oral submucous fibrosis.

BACKGROUND: Oral submucous fibrosis (OSMF) is a widely prevalent, potentially malignant disorder of the oral cavity in the Indian subcontinent. Areca nut has been incriminated as the main causative factor. However, other factors, including viruses may also play a role in the initiation/development of these lesions. This study was designed to assess the correlation of addictive factors, human papilloma virus infection and histopathology of OSMF. METHODS: One hundred and thirteen cases of OSMF were studied. Demographic information of each patient, including the patient's age, sex, addiction habits and histopathological grading was obtained. Presence of high-risk human papilloma virus (HR-HPV) DNA was detected using the Hybrid Capture II assay. RESULTS: Of 105 cases finally included in the study, 33 (31.4%) patients were found to be positive for HR-HPV, while 72 (68.6%) were negative. A total of 52/105 (49.5%) patients chewed areca nut, of whom 18 (34.6%) patients were found to be positive and 34 (63.5%) were negative (P = 0.08). A total of 18/105 (17.1%) patients were addicted to smoking, of whom five (27.7%) were positive (0.69). Only one (11.1%) patient, who was only habituated to alcohol, was positive (1.08). Of the 105 patients 26 (24.7%) chewed as well as smoked tobacco, of whom, nine (34.6%) were positive and 17(65.3%) were negative (P = 0.67). Thus, there was no significant association between the various addiction habits and the presence of HR-HPV. On correlating the various histopathological grades of the disease with HR-HPV positivity a Pearson correlation of 0.053 was obtained (P = 0.588). Thus, again no significant correlation was observed between the different histopathological grades and HR-HPV positivity. CONCLUSION: In conclusion, it was found that there is neither significant correlation between HR-HPV infection and the various addiction habits nor with the different histopathological grades of the disease. To the best of our knowledge, a study of these different factors has never been attempted before in patients with OSMF.

Lipid profile in oral submucous fibrosis.

BACKGROUND: Changes in lipid profile have long been associated with malignancies as lipids play a key role in maintenance of cell integrity. This study evaluated the alterations in extended lipid profile in untreated patients of oral submucous fibrosis (OSMF) and studied the correlation between lipid levels with tobacco consumption. MATERIALS AND METHODS: In this hospital-based study, 65 clinically diagnosed and histopathologically proven patients of OSMF and 42 age and sex matched controls were studied. In these samples serum lipids including: (i) Total cholesterol, (ii) LDL cholesterol (LDLC), (iii) HDL cholesterol (HDLC) (iv) VLDL cholesterol (VLDLC) (v) triglycerides (vi) Apo-A1 (viii) Apo-B and (viii) LPa were analyzed. RESULTS: A significant decrease in plasma total cholesterol, HDLC and Apo-A1 was observed in patients with OSMF as compared to the controls. Thus an inverse relationship between plasma lipid levels and patients was found in OSMF. CONCLUSION: The lower levels of plasma cholesterol and other lipid constituents in patients might be due to their increased utilization. The findings strongly warrant an in-depth study of alterations in plasma lipid profile in patients with oral precancerous conditions.

Correlation of histopathological diagnosis with habits and clinical findings in oral submucous fibrosis.

BACKGROUND: Oral submucous fibrosis is a common oral health problem in India. This study was conducted to correlate the histopathological diagnosis with habits and clinical findings in patients suffering from oral submucous fibrosis (OSF). METHODS: Patients suffering from oral submucous fibrosis from the Departments of Otorhinolaryngology and Pathology, Moti Lal Nehru Medical College, Allahabad, India were studied from 2004-2008. Detailed information was gathered in a pretested proforma. Emphasis was given to the various addictions, clinical findings and histological examination was done. RESULTS: Two hundred and thirty nine patients were studied, yielding a male to female ratio of 6.8:1. Maximum patients were in the 21-30 years age group with a marked male predominance. Of these, 197 (82.4%) patients chewed areca nut/dohra, 14 (5.8%) were smokers and 2 (0.8%) patients were habituated to alcohol. 89 (37.2%) patients reported difficulty in opening of the mouth (trismus). 51 (57.4%) patients were found to have stage II (2-3 cm) trismus while rest had stage I and III. The buccal mucosa was found to be the most commonly involved site. On the basis of histopathological examination, 52 (21.7%) were classified as OSF grade I, 75 (31.3%) patients as grade II and 112 (46.8%) had grade III disease. CONCLUSION: The widespread habit of chewing dohra/paan masala is a major risk factor of OSF, especially in the younger age group. In this study, an increase in histopathological grading was found with severity and duration of addiction habit. However no significant correlation was found between clinical staging and histopathological grading.

Spectrum of malignancies in Allahabad, North India: a hospital-based study.

OBJECTIVE: To study the spectrum of malignancies in the Allahabad region of North India. This was a hospital-based analysis of malignancies from January 1991 to October 2006. MATERIALS AND METHODS: The basic information in the cancer registry included data on personal identification, demographic characteristics, diagnosis, primary site and morphology of tumours. The basis of diagnosis was histological examination of the biopsy material. RESULTS: Total of 58,031 biopsies were examined, out of which 3,133 (5.4%) were diagnosed as malignancies. Of these, 1,893 (60.4%) patients were males and 1,240 (39.6%) were females, yielding a male: female sex ratio of 1.5:1. The majority of cases (2,772, 88.5%) were above the age of 30, with predominance at 41-50 years of age group (804, 25.6%). Most commonly reported tumours were those of oral cavity (370; 11.8%), oesophagus (267; 8.5%), stomach (239, 7.6%), oropharynx (207, 6.6%), cervix (192, 6.1%), breast (190, 6.0%), larynx (101, 3.2%), skin (81, 3.2%), prostate (77, 2.4%) and the urinary bladder (66, 2.1%). CONCLUSIONS: It is concluded from this retrospective study of tumours reported at this hospital over 16 years, that oral and oropharyngeal malignancies were the commonest malignancies in men, while in females, carcinoma of cervix and breast were the most frequent.

Prevalence of oral pre-malignant and malignant lesions at a tertiary level hospital in Allahabad, India.

OBJECTIVE: In a previous article, we reported the prevalence rates of oral mucosal lesions in this hospital from 1990-2001. This study was planned to study the spectrum of potentially malignant and malignant oral lesions in Allahabad, North India in the subsequent years till 2007 and to assess change in pattern of prevalence, if any. MATERIALS AND METHODS: This is a single institutional retrospective study in and around Allahabad from 1990 to 2007. Data was collected year wise with reference to age, sex, site involved and histopathological findings. RESULTS: 1,151 oral biopsies were reviewed. Of these, 365 biopsies were benign, 344 were potentially malignant and 442 were malignant. The buccal mucosa was the most frequently involved site in benign and premalignant lesions, however in malignant lesions, the tongue was most common site. Oral submucous fibrosis constituted the highest number of patients in premalignant group, while in malignant group, squamous cell carcinoma was most prevalent. CONCLUSION: This study showed that potentially malignant and malignant oral lesions were widespread in the patients visiting the hospital in this region.

The use of an oral brush biopsy without computer-assisted analysis in the evaluation of oral lesions: a study of 94 patients.

OBJECTIVE: The objective of this study was to evaluate the sensitivity and specificity of modified brush biopsy without computer-assisted analysis in the detection of oral premalignant and malignant lesions. STUDY DESIGN: Ninety-four patients attending outpatient clinics who exhibited oral lesions suspicious of premalignancy or malignancy were enrolled. All patients underwent an oral brush biopsy using a baby toothbrush followed by a scalpel biopsy. The specimens were analyzed manually in a double-blinded fashion. Sensitivity and specificity were used for the statistical analysis of the samples. Statistical significance was determined using the normal approximation to the binomial distribution of matched results, approximated by the Student t distribution mean test (paired t test). RESULTS: Seventy-nine patients with adequate transepithelial brush biopsy samples were included in the study group. When compared to scalpel biopsy, the statistical sensitivity of the brush biopsy was greater than 76.8% (P < .05) while the statistical specificity was greater than 93.3% (P < .05). There were 4 false negative brush biopsy cases. The 4 false negative patients turned out to be dysplasia/ malignancy on histopathology. All 4 were patients with clinical oral submucous fibrosis. CONCLUSION: The oral brush biopsy without computer-assisted analysis was found to be a painless, noninvasive test for evaluating oral lesions. The toothbrush brush biopsy with manual analysis had much [corrected] lower sensitivity and specificity than the commercially available oral brush biopsy with computer-assisted analysis. The results demonstrate that by using a toothbrush to obtain an oral brush biopsy sample, oral lesions can be easily evaluated in a resource challenged settings to rule out dysplasia and carcinoma.