Effect of High Serum Ferritin on Extent of Involvement of COVID-19 Associated Mucormycosis.

Coronavirus disease 2019 attributed to severe acute respiratory syndrome has been implicated with life threatening opportunistic infections like mucormycosis. COVID-19 is a hyperferritinemic syndrome and emerging data project the role of iron in the susceptibility and pathogenesis of mucormycosis but whether high ferritin is an indicator of severity of mucormycosis is debated. The study aimed to determine the relationship between serum ferritin levels and the extent of involvement of COVID-19 associated mucormycosis. A hospital based observational study was conducted with a sample size of 70. All biopsy confirmed cases of COVID-19 associated mucormycosis were included. Retrospective data from hospital records prepared at the time of patient admission were retrieved. The imaging data was used to determine the extent of disease involvement and serum ferritin values were analysed. During the study period 40 patients had mild extent mucormycosis and 30 had severe extent. A statistically significant difference was seen in levels of serum ferritin between mild extent mucormycosis and severe extent involvement (p < 0.01). COVID-19 associated Mucormycosis patients tend to have higher serum ferritin values especially in severe extent disease and with active COVID-19 infection along with diabetes mellitus as a potent aggravating factor.

Colistin (Polymyxin E) Use in Abdominal Solid Organ Transplant Recipients.

Background: Patients undergoing solid organ transplantation are at a higher risk of multi-drug resistant (MDR) bacterial infections especially during the immediate post operative period. Objective: To audit the usage, dosage appropriateness and safety of colistin use in abdominal solid organ transplant recipients to treat immediate post-transplant bacterial infections. Methods: After completion of 1000 abdominal solid organ transplants at our institute, data of the transplant recipients who received colistin between October 2010 and December 2019 was extracted from the hospital health information system. Data of all microbiological culture isolates, the minimum inhibitory concentration (MIC) of colistin, appropriateness of colistin dosing and nephrotoxicity associated with colistin use was assessed. Results: Of the 1170 (732 liver and 438 renal) solid organ transplant recipients, 82 (66 liver and 16 renal) received colistin to treat posttransplant MDR bacterial infections. Nearly 60% received colistin as definitive therapy and 87.81% received colistin as combination. Mean duration of colistin therapy was found to be higher in renal than liver transplant recipients. Out of the total 89 bacterial isolates, there were 2 colistin resistant Klebsiella strains. Colistin in combination with meropenem (36.4%) was the most commonly used dual therapy. Out of the total 89 bacterial isolates, there were 2 colistin resistant Klebsiella strains. Overall in-hospital mortality of patients who received colistin was 43.9%. Renal impairment occurred in 28.8% of liver transplant recipients. Conclusion: Infection necessitating colistin use increases mortality by three folds in liver transplant recipients and by five percentage points in renal transplant recipients.

Assessment of the anti-oxidant reduced glutathione in oral squamous cell carcinoma - Systematic review and meta-analysis.

Background: The excess reactive oxygen species or free radicals reaction leads to oxidative injury to the biological components such as cells and tissues, which would result in the initiation and progression of carcinogenesis. The magnitude of oxidative damage depends primarily on the balance between free radicals (pro-oxidants) and antioxidant system activity. Aim: To assess antioxidant status by evaluating the reduced glutathione (GSH) levels in various biological samples of patients with oral squamous cell carcinoma (OSCC) using available literature. Materials and Methods: An electronic literature search was carried out in PubMed (MeSH), Science Direct, Scopus and Cross Reference by using specific keywords. Results: The systematic electronic search identified 704 articles. After studying the articles' titles and abstracts, 657 articles were excluded for the following reasons; duplicated articles, animal studies, studies of low quality and not relevant to the research question. The remaining 47 articles were selected for full-text assessment. After eliminating the articles that did not match the objectives, the present qualitative synthesis finally included 27 articles for evaluation. The ten studies, which showed coherent data, were included in quantitative analysis. The GSH levels in OSCC groups are significantly decreased (P < 0.001) in plasma and erythrocyte samples compared to healthy controls. Conclusion: The selected studies showed significantly lower levels of GSH in various biological samples of OSCC. Hence, future studies are required to validate the expression of GSH as a prognostic biomarker in oral cancer.

Efficacy of herbal alternatives in maintaining oral health in cancer patients: A systematic review.

Herbal rinses possess different medicinal properties. Numerous studies have reported the usefulness of various herbal oral rinses. Few studies claimed that herbal rinses are superior to synthetic mouth rinses for certain purposes, but there appears to be a lack of sound scientific evidence to prove the efficacy of herbal rinses in controlling oral plaque in cancer patients. This review analyses the various clinical studies on herbal rinses and aims to find the safety and efficacy of red ginseng mouth rinses over other available mouth rinses in carcinoma patients. A thorough electronic search was conducted in various databases and 10 articles were included in the review based on the inclusion and exclusion criteria. The data extracted were tabulated and analyzed. The risk of bias table was drawn. Meta-analysis was not performed due to the heterogeneity of the included studies. Of the 10 clinical trials included in the review, three studies appeared to have low risk of bias. The mean follow-up period was 14 days, ranging from 7 to 21 days. The sample size in each study was reported to be between 10 and 50, except one study with 240 samples. Seven studies have reported a significant difference between the herbal mouth rinse group and the chlorhexidine group. Of all the herbal rinses, mouth rinses with ginger extracts show more efficacy over other herbal rinses and red ginseng appears to be a more safer herbal rinse. Based on the available evidence, herbal mouth rinses are comparable to synthetic mouth rinses in their anti-bacterial properties. The red ginseng with anti-bacterial, anti-inflammatory and anti-cancerous properties may be an alternative mouth rinse in cancer patients. However, further clinical trials with more samples are required for better evidence.

Rare histologic presentation of pleomorphic adenoma: A diagnostic dilemma.

Pleomorphic adenoma is the most common benign salivary gland tumor deriving its name from varied morphological patterns in histopathology. The presence of chondromyxoid stroma in histopathology is characteristic of pleomorphic adenoma. Cellular variants without characteristic chondromyxoid stroma are rare and often pose a diagnostic challenge. We report a case of pleomorphic adenoma involving minor salivary glands of the palate presenting with a predominantly cellular histopathology. Immunohistochemical workup was pivotal in the diagnosis of this challenging case.

Cheiloscopy and dermatoglyphics as screening tools for type 2 diabetes mellitus.

AIM: The aim of this study is to evaluate the efficacy of cheiloscopy (the study of lip prints) and dermatoglyphics (the study of fingerprints) in screening diabetic patients. MATERIALS AND METHODS: The study sample comprised 100 individuals in the age group of 17-60 years, of which fifty were diabetics and fifty controls who reported to the Department of Oral Medicine, Thai Moogambigai Dental College and Hospital. Lip prints were collected and categorized based on the Suzuki and Tsuchihashi system. Fingerprint patterns were obtained and classified according to the Henry's system of classification. RESULTS: Type II and IV lip print patterns were predominant in diabetic patients and Type I lip print patterns in controls. The difference was statistically significant. There was no significant difference in fingerprint patterns between the study groups. Gender-wise analysis for lip print and fingerprint patterns did not yield significant results. CONCLUSION: Cheiloscopy is a potential screening tool for type 2 diabetes mellitus. Dermatoglyphics cannot be used as a screening tool in type 2 diabetes mellitus.

Dental anxiety and influencing factors: A cross-sectional questionnaire-based survey.

BACKGROUND: Dental treatment still remains as one of the most anxious visits despite awareness between dentists and patients in building trusting relationships. The fear of dental treatment determines the frequency of treatment availed with long-term implications in oral health maintenance. AIM: This study aims to estimate prevalence, extent, and factors influencing dental anxiety in a sample of the adult population visiting a private dental hospital in Chennai, India. MATERIALS AND METHODS: The study sample included 300 consecutive outpatients visiting a private dental hospital in Chennai. Any patient aged 18 and above was considered for the study. A structured custom-made questionnaire composed of ten questions was designed to assess the anxiety levels of dental patients. The level of the patient's anxiety was assessed taking into account various factors that could influence their mental state. This included their age, gender, educational qualification, number/frequency of their dental visits, reason for their visit, past dental experiences, and nature of the dental procedure planned. Enquiries about the related time of anxiety manifestations as well as their preferred anxiety reducing protocols were done as part of the study. STATISTICS: The data analysis was performed using SPSS Version 11.5. Analysis initially was performed with Chi-square test for frequency and reason of visit, with the independent samples t-test used for assessing mean score differences along with Pearson's correlation coefficient. RESULTS: The study revealed that dental anxiety has a wide prevalence rate encompassing both genders. Distinctive predominance among females (65.2%) and professionals (66.9%) exhibiting a greater degree of anxiety was identified. Pain and extraction have been cited as duress and anxiety inciting procedures (72.6%). CONCLUSION: This survey has revealed that age, gender, level of education, and procedure along with visit frequency has a direct effect on the patient's state of mind and anxiety.

Comparison of the efficacy of herbal mouth rinse with commercially available mouth rinses: A clinical trial.

AIM: The aim of the study was to compare the efficacy of an herbal mouthwash containing red ginseng extract with different brands of commercially available chemical mouthwashes. OBJECTIVE: The objective of the study was to evaluate the effectiveness of herbal mouthwash (Dr. Dental care liquid) in reducing the oral bacterial count and compare it with the efficacy of commercially available mouthwashes such as Rexidine, Listerine and Colgate Plax. MATERIALS AND METHODS: The study includes sixty normal individuals (aged 18-24 years) who were divided into four groups of 15 individuals each. The participants of each group were given four different mouthwashes (Dr. Dental Care liquid, Colgate Plax, Listerine and Rexidine) and asked to use it twice daily for 5 days. Saliva samples were collected before the use of mouthwash and also after 5 days of using the mouthwashes. Culture and microscopic examination of salivary samples was done, and oral bacterial load present in the saliva samples was counted before and after the mouth rinse use. RESULTS: The results were compared using Wilcoxon sign-rank test. Among the four mouthwashes, the herbal mouthwash, Dr. Dental care liquid exhibited maximum efficacy in reducing the amount of bacteria followed by Colgate Plax, Listerine and Rexidine. CONCLUSION: The herbal mouthwash, Dr. Dental care liquid, contains red ginseng extract, a herb with immense medicinal values. In this study, the herbal mouth rinse exhibited increased antibacterial action compared with other commercially available chemical mouth rinses. Hence, we conclude that the ginseng-containing herbal mouthwash can be considered as a safe and effective oral hygiene aid.

Membranous Basal Cell Adenoma - A Rare Entity in an Unusual Location.

Basal cell adenoma is a rare benign salivary gland neoplasm exhibiting an isomorphic basaloid tumour cell pattern, commonly occurring in the parotid. Membranous variant warrants separate consideration because of its recurrence and rate of malignant transformation. We report a case of membranous type basal cell adenoma occurring in minor salivary gland in a 61-year-old female patient. The histopathological diagnosis was supported by immunohistochemical analysis and serum Carcinoembryonic antigen level.

Tongue prints in biometric authentication: A pilot study.

BACKGROUND AND OBJECTIVES: Biometric authentication is an important process for the identification and verification of individuals for security purposes. There are many biometric systems that are currently in use and also being researched. Tongue print is a new biometric authentication tool that is unique and cannot be easily forged because no two tongue prints are similar. The present study aims to evaluate the common morphological features of the tongue and its variations in males and females. The usefulness of alginate impression and dental cast in obtaining the lingual impression was also evaluated. MATERIALS AND METHODS: The study sample included twenty participants. The participants were subjected to visual examination following which digital photographs of the dorsal surface of the tongue were taken. Alginate impressions of the tongue were made, and casts were prepared using dental stone. The photographs and the casts were analyzed by two observers separately for the surface morphology including shape, presence or absence of fissures and its pattern of distribution. Three reference points were considered to determine the shape of the tongue. RESULTS: The most common morphological feature on the dorsum of the tongue was the presence of central fissures. Multiple vertical fissures were observed in males whereas single vertical fissure was a common finding in females. The fissures were predominantly shallow in males and deep in females. The tongue was predominantly U shaped in males and females. V-shaped tongue was observed in 25% of females. CONCLUSION: Tongue prints are useful in biometric authentication. The methodology used in the study is simple, easy and can be adopted by dentists on a regular basis. However, large-scale studies are required to validate the results and also identify other features of the tongue that can be used in forensics and biometric authentication process.

Current trends in forensic odontology.

Forensic odontology is an evolving science and has a greater scope of development. It has established as an indispensable science in medico-legal matters and in the identification of the dead person. The dental tissues are often preserved even if the deceased person is skeletonized, decomposed, burnt, or dismembered. Various methods have been developed to determine age, sex, and ethnicity of the person, using dental tissues. Data collection methods and supplementary technologies used in forensic dental identification have undergone significant transformation. This article provides an overview of the evolving trends in conventional methods, and the recent concepts used in forensic odontology.

Awareness about medico legal aspects and Consumer Protection Act among dentists.

BACKGROUND: The practice of medicine in India has undergone considerable change affecting delivery of health in both positive and negative directions. As a result, there was a growing feeling that medical treatment should be made accountable and this led to doctors and dentists becoming subject to the process of law. Patients have become more aware of their right to compensation and as a consequence doctors and dentists should be knowledgeable about the laws that govern them. AIMS AND OBJECTIVES: To assess the awareness about Medico legal aspects and Consumer Protection Act [CPA] among Dental professionals. MATERIALS AND METHODS: A self-structured validated questionnaire comprising of 20 questions related to medico legal aspects and CPA was designed. A total of 450 dental professionals were surveyed from 4 prime dental institutions in Chennai, India. Of the 450 professionals that were surveyed 150 were MDS faculty, 150 were BDS faculty and 150 were PG students. The data was subjected to SPSS, version 16 and statistically analysed using Chi square test and Fisher's exact test. A- p value less than 0.05 was considered to be statistically significant. RESULTS: BDS faculty, MDS faculty and PG students were found to possess similar level of understanding and there was no significant difference between the groups. Knowledge was found to be equal between male and female dentists. The young practitioners were found to be more informed about CPA than the senior practitioners. CONCLUSIONS: It was found that most of the participants were aware of relevant Medico legal aspects, but were less aware of CPA. This study emphasises the need for education relevant to Medico legal aspects and CPA for dental professionals.

Screening of oral potentially malignant disorders: Need of the hour.

Oral potentially malignant disorders (OPMDs) include a variety of lesions and conditions which display an increased risk for malignant transformation to oral cancer. As the incidence and prevalence of OPMD are highly increasing in India, its early detection and prevention is the need of the hour. Early diagnosis of such disorders is necessary to prevent the malignant transformation. Many advanced diagnostic techniques are used to predict their progression and to assess the risk of malignant transformation. Management of symptoms of OPMDs is necessary for the overall well-being of the patient. This short communication provides an overview and the importance of early diagnosis and prevention of OPMDs.

Salivary biomarkers in oral squamous cell carcinoma - An insight.

Oral cancer refers to the malignancies that occur in the oral cavity, lip and pharynx with 90% of oral cancers being squamous cell carcinomas (OSCC). OSCC has the highest mortality ratio compared to other carcinomas. Although oral cavity is easily accessible, most oral cancers are detected at a later stage leading to lower survival rates. Early detection of OSCC is a key factor in improving the prognosis and survival rate of the patient. Rapid advancement in the field of diagnosis has enabled early diagnosis of many potentially malignant conditions even before its clinical manifestations. One such diagnostic modality that has gained much relevance in the field of molecular biology has been the discovery of salivary biomarkers (DNA, RNA and protein markers). These salivary biomarkers have been shown to play a non-invasive role in the diagnosis and surveillance of oral cancer. The direct contact between the saliva and the oral cancer lesions makes it a most sensitive and specific, screening method in diagnosis, staging and follow-up. This review aims to discuss the effectiveness and the potential of salivary biomarkers as a screening tool in OSCC.

Qualitative Analysis of Collagen Fibers in Oral Submucous Fibrosis using Picrosirius Red Stain and Polarising Microscope.

INTRODUCTION: Oral Submucous Fibrosis (OSMF) is an oral potentially malignant condition caused predominantly by areca nut chewing. Early recognition with accurate staging of the disease and appropriate treatment planning is of utmost importance to prevent the malignant transformation and to improve the quality of life of the patient. Picrosirius red stain is specific for collagen and enhances its birefringence under polarising light producing different colours in different stages of the disease. AIM: To compare the clinical and functional staging with histopathologic staging methods used to assess the severity of OSMF and to perform a qualitative analysis of the collagen fibres in various histopathologic stages of OSMF using picrosirius red stain and polarising microscope. MATERIALS AND METHODS: It is a retrospective study done on archival samples. The study sample included a total of 30 cases which was divided into two groups. Group I comprised of 20 OSMF samples and Group II comprised of 10 normal tissue samples. Clinical, functional and histopathological staging was performed for all OSMF samples. Comparative analysis between clinical and functional stages with the histopathological staging was done using chi square test. Picrosirius red- stained sections of OSMF were analysed using polarising microscopy to evaluate the qualitative changes in the collagen fibers. STATISTICAL ANALYSIS USED: Descriptive data which includes frequency and percentages were calculated for each group. Categorical data were analysed by chi-square test. A p-value of 0.05 or less was considered statistically significant. RESULTS: Comparative analysis between clinical and functional stages with the histopathological staging revealed a significant correlation (p < 0.05) between the functional and histopathological stage. Enhanced birefringence of the collagen fibers due to picrosirius red stain yielded characteristic prominent polarising colours in different stages of OSMF. CONCLUSION: Comparison of functional staging with histopathologic grading is more reliable in determining the severity of the disease than the clinical staging. Production of characteristic polarising colours by various stages of picrosirius red stained sections of OSMF substantiates the use of picrosirius red stain and polarising microscope as a tool in assessing the severity of this condition thereby aiding in better treatment planning.

Tongue prints: A novel biometric and potential forensic tool.

Tongue is a vital internal organ well encased within the oral cavity and protected from the environment. It has unique features which differ from individual to individual and even between identical twins. The color, shape, and surface features are characteristic of every individual, and this serves as a tool for identification. Many modes of biometric systems have come into existence such as fingerprint, iris scan, skin color, signature verification, voice recognition, and face recognition. The search for a new personal identification method secure has led to the use of the lingual impression or the tongue print as a method of biometric authentication. Tongue characteristics exhibit sexual dimorphism thus aiding in the identification of the person. Emerging as a novel biometric tool, tongue prints also hold the promise of a potential forensic tool. This review highlights the uniqueness of tongue prints and its superiority over other biometric identification systems. The various methods of tongue print collection and the classification of tongue features are also elucidated.

Single Rooted Permanent Premolars and Molars - A Rare Clinical Presentation Confirmed using Cone Beam Computed Tomography.

The morphology of the root and root canal system plays a significant role in the treatment outcome of endodontic procedures. The necessity of clear and high contrast images for tissues like bone and teeth has made the usage of newer imaging techniques inevitable. This is a rare case report wherein, the permanent posterior dentition of both arches was single rooted. While sporadic cases of single rooted teeth have been reported, it is rare for all the premolars and molars to show such variation. This rare clinical observation has been enhanced by Cone Beam Computed Tomography (CBCT), which provides a clear image with added benefits of 3D (Three Dimensional) image reconstruction, low dosage and rapid scan time.

Polymorphous Low Grade Adenocarcinoma of Retromolar Region - A Rare Case Report with Distinct Clinical Manifestations.

Polymorphous low grade adenocarcinoma (PLGA) is a rare, low-grade malignancy of minor salivary glands accounting for 2% of salivary gland tumours. The most common sites are palate (60%), lip, buccal mucosa, alveolar ridge and base of the tongue with retromolar region being very rare (0.5%). It is considered to be a low grade malignancy with indolent nature. Very few cases with metastatic spread to lymph nodes and lung have been reported in literature. This report of PLGA is a rare case presenting in an uncommon location (retromolar area) with suspected lymph node and lung metastases.

Loricrin - an overview.

Loricrin is a terminally differentiating structural protein comprising more than 70% of the cornified envelope. It contributes to the protective barrier function of the stratum corneum. In vivo, loricrin is expressed inall mammalian stratified epithelia with the highest levels of expression in humid tissues such as newborn epidermis, the epithelia of oral and anal mucosa, esophagus, foreskin, vagina and the epidermal parts of sweat ducts. Loricrin is not expressed in non keratinizing epithelia and its expression at these sites actually represents a defensive or protective mechanismof the body. An insight into this protein- "Loricrin" can shed light to its potential as a marker in the early stages of potentially malignant disorders like oral sub mucous fibrosis and leukoplakia. This compilation has been done by taking into account the existing literature, reviews and original studies on loricrin, a major component of the cornifiedcell envelope, its structure and the alterations that result due to its absence or presence of both the epidermis and the oral mucosa.

Peripheral squamous odontogenic tumor.

A case of peripheral squamous odontogenic tumor is described in a 60-year-old female who presented with a sessile growth in the right posterior mandible. Radiographic examination revealed no evidence of a central lesion in bone. With the characteristic histopathological picture of benign-appearing islands of squamous epithelium scattered randomly against a background of mature fibrous connective tissue, the tumor was diagnosed as peripheral squamous odontogenic tumor (PSOT). The epithelial islands showed peripheral cuboidal or flattened cells, microcyst formation, individual cell keratinization, and keratin pearl formation.