Characterization of Herbal Antifungal Agent, Origanum vulgare against Oral Candida spp. Isolated from Patients with Candida-Associated Denture Stomatitis: An In vitro Study.

BACKGROUND: Candida Associated Denture Stomatitis is the prevalent fungal pathosis in denture wearers, especially in immunocompromized patients. Existing antifungal agents are ineffective since the Candida species become resistant and also, they become toxic. Origanum vulgare is a herbal plant with high anti-fungal activity against Candida of blood and urine origin. However, it has never been explored against Candida from oral cavity. MATERIALS & METHODOLOGY: Dry leaves of the plant were purchased and authenticated. Oil extraction was done using Hydro-distillation method. Clinical isolates of Candida from denture wearers was speciated using CHROMagar. Well Diffusion test was used to confirm the antifungal activity. Hydro-distillation & Maceration methods of extraction were compared. MIC/MFC was determined using CSLI guidelines. Infra-Red Spectroscopy was used to identify the active functional group. RESULTS: O.vulgare showed 30±3mm of zone of inhibition as against 19mm for fluconazole. The suitable extraction method was Hydro-distillation. MIC & MFC were found to be 0.024% and 0.097% respectively which was much lesser than for fluconazole (0.25%). The active functional group had chemically similar structure as Carvacrol, usually found in antifungal herbs. CONCLUSION: within the limitations of the study, it was concluded that (a)O.vulgare is anticandidal for clinical isolates of oral Candida, (b) Hydro-distillation is an effective method as compared to Maceration (c) MIC & MFC are much lower than that of fluconazole (d) the major functional group was structurally similar to Carvacrol.

Hydroxychloroquine retinopathy: an emerging problem.

PurposeThe aim of this case series is to raise awareness of the emerging issue of serious retinal damage caused by the prolonged use of hydroxychloroquine (HCQ) and the importance of adequate and appropriate monitoring of visual function during treatment.Patient and methodsThis is a small retrospective case series of 3 patients on long-term HCQ who developed serious symptomatic retinal toxicity confirmed on imaging and functional testing.ResultsAll 3 patients were treated with HCQ for over 15 years; two for rheumatoid arthritis (RA), and the third for systemic lupus erythematosus (SLE). All 3 patients had macular involvement varying in severity confirmed with characteristic features on imaging and functional testing (Optical Coherence Tomography (OCT), Autofluorescence (AF) and Humphrey 10-2 visual fields).ConclusionHCQ is widely used to treat autoimmune conditions with a proven survival benefit in patients with SLE. However, long-term use can be associated with irreversible retinal toxicity. These cases highlight that HCQ, like chloroquine, can also cause visual loss in susceptible individuals. Early detection of presymptomatic retinal changes by the introduction of appropriate screening and monitoring is mandatory to limit the extent of irreversible visual loss due to HCQ retinal toxicity.

Single nucleotide polymorphism of bone morphogenetic protein 4 gene: A risk factor of non-syndromic cleft lip with or without palate.

BACKGROUND: The bone morphogenetic protein (BMP) signalling pathway is crucial in a number of developmental processes and is critical in the formation of variety of craniofacial elements including cranial neural crest, facial primordium, tooth, lip and palate. It is an important mediator in regulation of lip and palate fusion, cartilage and bone formation. AIM: To study the role of mutation of BMP4 genes in the aetiology of non-syndromic cleft lip with or without palate (NSCL ± P) and identify it directly from human analyses. MATERIALS AND METHODS: A case-control study was done to evaluate whether BMP4T538C polymorphism, resulting in an amino acid change of Val=Ala (V152A) in the polypeptide, is associated with NSCL ± P in an Indian paediatric population. Genotypes of 100 patients with NSCL ± P and 100 controls (in whom absence of CL ± P was confirmed in three generations) were detected using a polymerase chain reaction-restriction fragment length polymorphism strategy. Logistic regression was performed to evaluate allele and genotype association with NSCLP. RESULTS: Results showed significant association between homozygous CC genotype with CL ± P (odds ratio [OR]-5.59 and 95% confidence interval [CI] = 2.85-10.99). The 538C allele carriers showed an increased risk of NSCL ± P as compared with 538 T allele (OR - 4.2% CI = 2.75-6.41). CONCLUSION: This study suggests an association between SNP of BMP4 gene among carriers of the C allele and increased risk for NSCLP in an Indian Population. Further studies on this aspect can scale large heights in preventive strategies for NSCLP that may soon become a reality.

Effect of dentin powder on setting time of mineral trioxide aggregate: an in vitro study.

AIM: Mineral trioxide aggregate (MTA) is a biomaterial with numerous clinical applications in the field of endodontics. The properties of this material come closest to the requirements of an ideal endodontic repair material. Delayed setting time though may limit the use of MTA in endodontic procedures. Many chemical based additives have influenced the setting time of MTA. The aim of this paper was to evaluate the effect of a natural additive in the form of human dentin powder on setting properties of ProRoot MTA (Dentsply/Tulsa Dental, Tulsa, OK). METHODS: Thirty extracted human teeth were taken to obtain fine dentin powder. The methodology used to obtain dentin powder for the present study was same as performed by Haapsalo et al. The specimens were divided into two groups. The samples were placed in standardized stainless steel ring moulds. The setting time of MTA alone and in equal proportions with dentin powder as an additive was evaluated using Vicats apparatus. RESULTS: MTA mixed with dentin powder showed faster setting time (70 minutes) in comparison to MTA without dentin powder (120 minutes) (P<0.5). CONCLUSION: Although MTA is an ideal retrograde material with increased efficacy due to reduced setting on addition of dentin powder. A combination of MTA with dentin powder might be a viable option in procedures where fast setting of the MTA is critical.

B-type natriuretic peptide levels predict extent and severity of coronary artery disease in non-ST elevation acute coronary syndrome and normal left ventricular function.

BACKGROUND: B-type natriuretic peptide has been used as a biological marker for prognosis in patients with acute coronary syndrome (ACS). However, a relation between the quantity of BNP levels and the severity of coronary artery disease has not been systematically evaluated. METHODS: 197 patients with ACS without ST elevation with normal LV systolic function were enrolled. BNP was measured in all recruited patients within 12 h of hospitalization. All patients underwent coronary angiography. We correlated BNP levels in patients with unstable angina (USAP) and non ST-elevation myocardial infarction (NSTEMI) with angiographic disease severity including Gensini Score. RESULTS: BNP levels were significantly higher in the NSTEMI group in comparison to the USAP Group (161 ± 149.3 vs 79.6 ± 94.2 pg/mL; p < 0.001). BNP levels rose significantly with increasing number of vessels involved (1-vessel = 51.4 ± 31.6; 2-vessels = 114.0 ± 67.8; 3 vessels = 265.4 ± 188.8 pg/mL, p < 0.001). Most importantly, BNP> 80 pg/ml was found to strongly predict the presence of Triple vessel disease (odds ratio 18.87; 95% confidence intervals 5.36-66.36), and Double vessel disease (odds ratio 3.62; 95% confidence intervals 1.75-7.47). In single vessel group, BNP was significantly higher when LAD was involved vessel (64.78 vs 49.76 pg/mL, p < 0.05). Gensini Score showed a strong correlation with BNP levels (r = 0.675, p < 0.01), and Gensini Score was significantly higher in those with BNP> 80 pg/ml (40.9 ± 29.7 vs 13.4 ± 16.5 p < 0.001). CONCLUSION: Circulating BNP levels appear elevated in Non ST Elevation ACS, even in the absence of LV systolic dysfunction. High BNP levels are associated with multi-vessel disease and diffuse coronary atherosclerosis.

Immunoglobulin levels and CD4 / CD8 counts in ß- thalassemia major.

OBJECTIVE: This cross-sectional study determined the CD4, CD8 counts and serum immunoglobulins in transfusion dependent b - thalassemic patients, and correlated them with anti-HIV, anti-HCV and HBsAg status, number of transfusions, iron overload and splenectomy. METHODS: Patients with acute or chronic diseases (except HIV, Hepatitis B and C), on immunosuppressive drugs or vaccinated within one month prior to study were excluded. CD4, CD8 counts and serum Immunoglobulins were documented. RESULTS: Increasing transfusions led to higher IgA and IgM as well as a decline in CD4 and CD8 levels. Higher ferritin correlated with high IgM. CD4, CD8 and IgA were significantly higher in splenectomized subjects. HCV correlated significantly with lower IgA values. CONCLUSION: Higher transfusion requirement, iron overload, splenectomy and HCV infection correlated with alterations in different immunological parameters.

Presurgical orthopaedic nasoalveolar molding in cleft lip and palate infants: a comparative evaluation of cases done with and without nasal stents.

Addressing the craniofacial anomaly of cleft lip and palate presurgically has been done since more than 50 years now, with a constant improvisation of the treatment protocols from time to time. The present study deals with a modification of the technique devised 16 years ago. The effect of nasal stents attached to a pre-surgical naso-alveolar molding (PNAM) appliance on the nasal morphology achieved prior to primary surgical correction of the cleft lip was to be evaluated. Twenty subjects, infants with cleft lip and palate, less than 2 months of age were selected for presurgical nasoalveolar molding treatment. Impressions were recorded, casts made and PNAM appliance fabricated. Ten infants were given the appliance without nasal stents and to the other ten appliances nasal stents were added. The patients were recalled every 2-3 weeks and a series of 9 measurements were recorded every visit along with adjustments made to the appliance for desirable effects on the lip, alveolus and nose. This was carried out till the patient was taken up for lip repair. The final measurements obtained at the end of the presurgical treatment were recorded. Mann-Whitney test, between study and control group showed that the increase in the columella length was statistically significant (p = 0.0001 and p = 0.033) in the study group as compared to the control group. Also the increase of the nasal tip projection (mean = 1.30 mm) in the study group was found to be statistically significant (p = 0.006) as compared to the control group. We concluded that nasal stents attached to the alveolar molding appliance, yield significant improvement of the nasal morphology and better nasal aesthetics presurgically.

Congenital muscular torticollis-case report and an effective treatment plan.

Congenital muscular torticollis results from shortening or excessive contraction of the sternocleidomastoid (SCM) muscle. The reported incidence varies between 0.4 and 1.9%. Various theories have been proposed, but its true aetiology remains obscure. The deformity is characterized by a practically painless, contracted cordlike SCM muscle, which pulls the head toward the side affected, narrows and draws the shoulder upward, forcing the chin in the opposite direction. Torticollis of congenital origin is a deformity not commonly met with in the practice of maxillofacial surgery. The rarity, lack of, or inadequacy of the previous treatment, together with the advanced age and marked deformity appear to warrant an investigation and report of the outcome. A case of congenital muscular torticollis is presented who reported at the age of 18 years and has been successfully treated by unipolar SCM release.

Standards of facial esthetics: an anthropometric study.

AIM: Anthropometry is an art and science used extensively for measuring the soft tissue proportions. While it is true that error is found in measurements of this kind, a great many trends of growth and development and therapy changes can be recorded with a significant degree of accuracy. OBJECTIVE: Facial proportion varies among the different ethnic groups and today, most of the available studies are done on western population. Hence an Anthropometric study was conducted in the local population. MATERIALS AND METHODS: The study was carried out with the aim of measuring the facial soft tissue proportion in the local population using anthropometry. Study was done using 100 subjects (50 males and 50 females) with Class I skeletal relationship and pleasing profile. Using standard anthropometric landmarks the various anthropometric measurements and facial proportional indices were determined (both horizontal and vertical) and were compared with that for North American Caucasians. RESULTS: The statistical analysis revealed significant differences in the facial proportion between the two populations.

A comparison of results using nasoalveolar moulding in cleft infants treated within 1 month of life versus those treated after this period: development of a new protocol.

UNLABELLED: The objectives of this study were to: evaluate the effects of nasoalveolar moulding (NAM) in complete unilateral cleft lip and palate infants presenting for treatment at different ages; propose a new NAM protocol in these patients; improve the predictability of NAM. Study groups comprised: group I (n=15) treated with NAM within 1 month of age; group II (n=15) treated with NAM between 1 and 5 months of age. CONTROL: group III (n=15) comprised of non-cleft 18-month old children. A standard protocol was followed. Patients were evaluated before initiation of NAM, before cheiloplasty and at 18 months. 7 linear anthropometric measurements were compared using dento-facial models. Statistical analysis before and after NAM revealed that group I patients demonstrated 81%, 198%, 69% and 145% improvement in intersegment distance, nasal height, nasal dome height and columella height respectively; whilst group II patients demonstrated 51%, 33%, 21% and 38% improvement for the same. At 18 months, group I patients closely resembled group III patients. This study concluded that the effects of NAM were most significant in group I. Group II patients also benefited from NAM, although to a lesser extent. This study validates the use of NAM in infants presenting late for treatment.

Assessment of deformities of the lip and nose in cleft lip alveolus and palate patients by a rating scale.

INTRODUCTION: Labial and nasal deformities have always been a fundamental problem in the treatment of cleft lip, alveolus and palate patients. The primary surgical treatment of nasolabial area is of paramount importance in order to obtain both an esthetical correction of the deformity and a progressive and a balanced development of mid-face. In this study the nasal deformities in patients with cleft lip, alveolus and palate (CLAP) were analyzed and the relevant role of the perinasal, perioral muscular balance and the inborn dislocation of the alar cartilages are presented. PATIENTS AND METHODS: 50 CLAP patients were analyzed, 40 UCLP and 10BCLP. The lip repair was done by modification of Millard's technique. The severity of the cleft appearance was evaluated pre and post operatively, according to a pre-agreed visual rating scale. There are 4° of severity of the deformity pre operatively (mild, moderate, severe and very severe) and post operatively 5 categories of outcome (excellent,very good, good, satisfactory and poor), depending on the scores obtained by summing up the points corresponding to different types of deformity. This scale is closely related to the American Cleft Palate classification of clefts. RESULTS: In the 40 UCLP patients, 8 excellent, 10 very good, 16 good and 6 satisfactory results were obtained following primary cheiloplasty. In 10 BCLP patients 1 very good, 7 good, 1 satisfactory and 1 poor result were obtained. CONCLUSIONS: During the primary repair, it is important to correct the abnormal position of ala nasi, the nasal floor and the base of the columella. Abnormalities in the insertion of the nasolabial muscles with their abnormal function contribute to the cleft nose deformities. Therefore the reconstruction not only the orbicularis muscle but also of the paranasal muscles is therefore important for a symmetrical growth of the nose. Separate suture of intrinsic orbicularis oris provide a better shape to the vermillion. The position of the alar cartilage plays an important role for the symmetry of the nose. It is necessary to place the alar base symmetrically in three dimensions.

The role of systemic condition in the management of maxillofacial infections.

Ludwig's Angina is a rare type of facial infection which formerly invariably was fatal but now with adequate surgical and antibiotic treatment has a much reduced mortality. In spite of the recent advances in therapy, rare and potentially life threatening complications may still arise from time to time and as a result account for significant morbidity and mortality. A case of Ludwig's angina reported at A.B Shetty Memorial Institute of Dental Sciences, Mangalore, India resulting in fatality, in spite of surgical and antibiotic treatment, due to underlying systemic condition and involvement of multiple resistant organisms. The condition was worsened by subsequent esophageal rupture and death occurred due to multiple organ failure.

Modified presurgical nasoalveolar molding in the infants with complete unilateral cleft lip and palate: a stepwise approach.

Presurgical orthopedics in one or the other form has been an important part of the multidisciplinary approach towards the better cleft care. Presurgical nasoalveolar molding (PNAM) was described as a modified approach to the conventional form of orthopedics. PNAM not only reduces the severity of the alveolar defect before surgery, it also reduces the nasal deformity bringing it near to the normal. Nonsurgical nasal correction forms an important adjunct to the primary nasal repair at the time of primary lip repair. However, acceptance of nasoalveolar molding in Indian set-up has not been wide spread due to various reasons such as lack of the resources and inability of the parents to comply with the frequent adjustment schedule. At the Nitte Meenakshi Institute of Craniofacial surgery at the Nitte University, Mangalore, authors have developed a modification of the PNAM appliance previously described in the literature. The key modification is done at the time of fabrication of the occlusal prosthesis. This modification has made the overall procedure simpler and at the same time helped to reduce the recall visits by half of the originally required. This article describes the fabrication procedure of the modified nasal alveolar molding appliance and the modified treatment protocol in a stepwise manner.

Bactericidal and anti-inflammatory properties of a standardized Echinacea extract (Echinaforce): dual actions against respiratory bacteria.

Common symptoms of upper respiratory infections, such as sore throat, cough, and inflammation, are often caused by bacteria, sometimes as a complication of virus infection. Extracts of Echinacea purpurea (Asteraceae) have been advocated traditionally for use by individuals suffering from these symptoms, although the underlying basis for the beneficial effects of Echinacea is not known. We hypothesized that Echinacea could inactivate certain respiratory bacteria and could also reverse inflammatory effects caused by these bacteria in epithelial cells. In order to test this we used a commercial standardized extract of Echinacea purpurea (Echinaforce), and a novel cytokine array system designed to measure simultaneously the levels of 20 different cytokines secreted by bronchial epithelial cell cultures in response to infection. Streptococcus pyogenes (Group A Strep), which is often associated with sore throat and more severe pulmonary infections, was readily inactivated by Echinacea, which also completely reversed the cellular pro-inflammatory response. Hemophilus influenzae and Legionella pneumophila were also readily inactivated, and their pro-inflammatory responses reversed. Staphylococcus aureus (methicillin-resistant and sensitive strains) and Mycobacterium smegmatis were less sensitive to the bactericidal effects of Echinacea however, but their pro-inflammatory responses were still completely reversed. In contrast some other pathogens tested, including Candida albicans, were relatively resistant. Thus Echinaforce) exerts a dual action against several important respiratory bacteria, a killing effect and an anti-inflammatory effect. These results support the concept of using a standardized Echinacea preparation to control symptoms associated with bacterial respiratory infections.

Fiberoptic assessment of laryngeal mask airway placement: a comparison of blind insertion and insertion with the use of a laryngoscope.

BACKGROUND AND OBJECTIVES: This study aims to compare the frequency of ideal anatomic placement of the Laryngeal Mask Airway (LMA) using the traditional blind insertion approach with one where placement was facilitated by the use of a laryngoscope. Laryngeal Mask Airway is a supraglottic device in providing general anaesthesia. METHODS: A prospective comparison of 60 patients divided into 2 groups (30 with the blind technique and 30 with the direct technique) were evaluated with 2 airway assessment methods, Wilson and Mallampati. We also considered whether there was a relationship between these criteria and the successful placement into an ideal position. Other variables were considered, including hemodynamics. Five placement visual ordinals were used to grade the LMA position. RESULTS: There was no statistically significant difference between group 1 and group 2 (P=0.279) in terms of Campbell category. There was no statistically significant relation between Wilson airway score or Mallampati class and Campbell category (p=0.633 and 0.239 respectively). There was no statistically significant difference in systolic and diastolic BP at 1, 2 and 5 min post insertion between the two groups, but there was a statistically significant difference in 1 and 2 minute post insertion pulse rate (P=0.004). CONCLUSION: Blind insertion technique is easier and simpler method for insertion of LMA and has a reasonable success during insertion, so it is recommended to be used.

Assessment of shoulder function after functional neck dissection and selective neck dissection (Levels I, II, III) in patients with carcinoma of tongue: a comparative study.

BACKGROUND AND OBJECTIVES: To compare shoulder function with respect to pain and disability in patients who have undergone nerve sparing neck dissection i.e. selective neck dissection (levels I, II, III) and functional neck dissection as a part of their treatment modality for carcinoma tongue on a follow up of minimum six months. MATERIAL AND METHODS: A total of 100 patients were selected for this study. 50 patients who had undergone selective neck dissection (levels I, II, III) and 50 who underwent functional neck dissection as a part of their treatment modality for squamous cell carcinoma of the tongue from January 2005 to January 2007 were asked to participate in this study. A standardized questionnaire was used to assess pain and disability. Pain and disability scores were then compared between the two nerve sparing dissections. RESULTS: 100% of the patients in Selective Neck Dissection (SND) (levels I, II, III) group and in Functional Neck Dissection (FND) groups complained of pain. Though there is pain present in both the treatment groups, no significant difference in the pain values was found between FND and SND (levels I, II, III) in any of the pain parameters. Disability was present in both the treatment groups. However patients who have undergone FND had significantly higher severity of disability when compared to SND (levels I, II, III) especially during activities which involve shoulder abduction like dressing, doing heavy household work, hair wash and washing clothes/dishes (5.18, 5.22, 5.5, 4.88 in FND and 2.26, 4.08, 4.58, 2.2 in SND (levels I, II, III) respectively. Disability perceived during other activities like doing heavy household and facial care was 2.08 and 1.84 in both the treatment groups respectively. INTERPRETATION AND CONCLUSION: Degree of shoulder morbidity is much higher in patients who have undergone FND as compared to SND (levels I, II, III) as a treatment modality for carcinoma tongue, even though both the treatment options are nerve preserving.

Evaluation of glutathione in oral squamous cell carcinoma.

PURPOSE: To estimate the RBC level of glutathione among oral squamous cell carcinoma cases and normal healthy individual. The study compares the pre and postoperative blood levels of glutathione in patients with oral squamous cell carcinoma. MATERIALS AND METHOD: In the present study a total of 45, age matched subjects were recruited. The 45 subjects were split into 15 subjects in control, 30 clinically and histopathologically diagnosed cases of oral squamous cell carcinoma who had not received any prior treatment. RESULTS: A statistically significant difference of mean value of glutathione levels in RBC of the control group was found to be higher than that of oral squamous cell carcinoma patient group. A noticeable rise in glutathione concentration in RBC of oral squamous cell carcinoma towards normal was seen postoperatively, however these variations were not statistically significant. CONCLUSION: Pre and postoperatively a marked variation in levels of glutathione was observed. In addition, it was noticed that the levels tended to shift closer to control/normal values postoperatively. The value of glutathione as a prognostic marker could be ratified if the study was carried out on a larger scale over a sustained period of time.

Accuracy of intraoperative frozensection in assessing margins in oral cancer resection.

OBJECTIVES: To study the accuracy of intraoperative frozen section diagnosis in assessing margins in oral cancer resection and to evaluate the role of frozen section diagnosis as a guide in resection of oral cancer lesions. PATIENTS AND METHODS: The fresh tissue samples from the margins of lesions of patient with preoperative diagnosis of oral squamous cell carcinoma were used. The frozen sections are prepared immediately and examined by oral pathologist for the study. The results of these sections were compared with the results of histologic findings obtained by routine paraffin embedded Haemotoxylin and eosin method. RESULTS: The total of 184 margins, from 47 patients were examined. 178 margins showed concordance with the permanent section of the same tissue sample (seven false negative and one false positive), an accuracy rate of 96.74%. CONCLUSION: Frozen section is a helpful tool in intraoperative decision making in indicated situation. The results are highly specific but only moderately sensitive. The surgeon and the pathologist must understand the limitations of frozen sections.