Report of terbinafine resistant Trichophyton spp. in Italy: Clinical presentations, molecular identification, antifungal susceptibility testing and mutations in the squalene epoxidase gene.

BACKGROUND: Numerous reports of resistance to terbinafine in Trichophyton spp. from all over the world are arousing justified attention and concern. Point mutations in the gene that encodes the squalene epoxidase (SQLE) enzyme are responsible for these therapeutic resistances. OBJECTIVES: Primary objective of the study was to describe first isolates of Trichophyton spp. resistant to terbinafine among the patients treated between September 2019 and June 2022 at the Dermatology Units of Ospedale Maggiore Policlinico and San Bortolo Hospital. Secondary objective was to study the resistance mechanism. METHODS: Patients with confirmed Trichophyton spp. infection has been treated with systemic and topical terbinafine. Patients were then re-evaluated 12 weeks after the therapy. Patients with incomplete or absent response to terbinafine underwent a new skin scraping for direct mycological examination, new identification of dermatophyte species from culture and MALDI-TOF, molecular species identification, antifungal susceptibility testing and molecular analysis of SQLE gene. RESULTS: We identified five patients without clinical response to treatment with terbinafine. The DNA sequencing of the ITS region identified one Trichophyton rubrum and four Trichophyton indotineae. The T. rubrum strain showed minimum inhibitory concentration (MIC) (90% growth inhibition) of 4 mg/L for terbinafine. The four T. indotineae strains showed a MICs range of 0.25-4 mg/L for terbinafine. The analysis of the SQLE gene in the T. rubrum strain showed a nucleotide substitution generating a missense mutation (L393F). The SQLE gene sequencing in the T. indotineae strains showed a nucleotide substitution generating a missense mutation (F397L) in two strains, a nucleotide substitution L393S in one strain and a nucleotide substitution F415C in another strain. CONCLUSIONS: We report the first cases of terbinafine-resistant Trichophyton isolates in the Italian population. Solid antifungal management programs will be needed to promote more responsible use of antimycotics and preserve their therapeutic efficacy to control antifungal resistance.

Evaluation of Proliferative Marker Ki-67 in Adenoid Cystic Carcinoma: A Retrospective Study.

AIM: Adenoid cystic carcinoma (ACC) is a malignant tumor of salivary gland origin. Although the histologic appearance of ACC is low grade, management of this malignancy is a distinct therapeutic challenge because of its tendency for perineural involvement and potential for distant metastasis. Ki-67 antigen is expressed during the G1, S, G2 and M phases in the cell cycle but is absent in the quiescent G0 phase in tissue sections. Aim of the study was to review hematoxylin and eosin stained slides in order to confirm the previous histopathological diagnosis as per the criteria given by World Health Organisation (WHO) and to evaluate the expression of cell proliferation marker, Ki-67 antigen in Adenoid cystic carcinoma and correlate the expression of Ki-67 antigen histopathologically with different grades in Adenoid cystic carcinoma. MATERIALS AND METHODS: Tissue samples of 32 cases (12 males and 20 females) were selected from minor salivary glands with age range from 21 to 70 years. Two paraffin-embedded sections of these total 32 cases each of 4 µm thick were cut on a rotary microtome. One section was stained using hematoxylin and Eosin (H&E) and the other was used for Immunohistochemical staining with Ki-67 antigen. RESULTS: Among these 32 cases of Adenoid cystic carcinoma, Histologically 14 (43.75%) tumors were classified in grade I, 8 (25%) were in grade II, and 10 (31.25%) were in grade III. The average percentage of Ki-67 expression was 27.12% in grade I, 34.43% in grade II and 38.45% in grade III. CONCLUSION: Ki-67 immunoreactivity increased with increase in histopathological grades of ACC. CLINICAL SIGNIFICANCE: Since Ki-67 is a useful marker for assessing the proliferative potential of tumors, the prognosis of patients can definitely be predicted.

Molecular Detection of Porphyromonas gingivalis in Chronic Periodontitis Patients.

AIM: In the current study, Porphyromonas gingivalis was identified in chronic periodontitis patients and healthy subjects by polymerase chain reaction (PCR) and its presence correlated with the severity of clinical periodontal parameters. MATERIALS AND METHODS: Subgingival plaque samples were collected with sterile curette and subjected to deoxyribonucleic acid (DNA) extraction and subsequent PCR for detection of P. gingivalis. RESULTS: Porphyromonas gingivalis was detected in 60% of patients of group II (pocket depth up to 5 mm), and in 93.33% of patients of group III (pocket depth more than 5 mm). One periodontally healthy subject in group I (probing depth < 3 mm) showed the presence of P. gingivalis. CONCLUSION: Detection frequency of bacterium increased significantly with increase in probing pocket depth (PPD), loss of attachment (LOA), and gingival index (GI). CLINICAL SIGNIFICANCE: Porphyromonas gingivalis is strongly associated with chronic periodontitis and its detection frequency positively correlates with the severity of periodontal destruction.

Pharmacogenetic study of long-term response to interferon-ß treatment in multiple sclerosis.

The aim of the study is the identification of genetic factors that influence the long-term response to interferon-ß (IFNß) (4-year follow-up). We performed a genome-wide association study in 337 IFNß-treated Italian multiple sclerosis patients at the extreme of treatment response, and we meta-analyzed association effects, integrating results with pathway analysis, gene-expression profiling of IFNß-stimulated peripheral blood mononuclear cells from 20 healthy controls (HC) and expression quantitative locus (eQTL) analyses. From meta-analysis, 43 markers were associated at P<10-4, and two of them (rs7298096 and rs4726460) pointed to two genes, NINJ2 and TBXAS1, that were significantly downregulated after IFNß stimulation in HC (P=3.1 × 10-9 and 5.6 × 10-10). We also observed an eQTL effect for the allele associated with favorable treatment response (rs4726460A); moreover, TBXAS1 appeared downregulated upon IFNß administration (ß=-0.39; P=0.02). Finally, we found an enrichment of pathways related to inflammatory processes and presynaptic membrane, the latter with involvement of genes related to glutamatergic system (GRM3 and GRIK2), confirming its potential role in the response to IFNß.

Collagen and Its Role in predicting the Biological Behavior of Odontogenic Lesions.

INTRODUCTION: Odontogenic cysts and tumors have variable recurrence rates. Recurrence rate is mainly due to the activity of the epithelium. The epithelium of these lesions has been investigated extensively in regard to their role in proliferative and aggressive behavior of the lesions. However, the role of the connective tissue wall in their behavior has not been studied as extensively. Collagen is an essential part of the connective tissue as a whole and fibrous wall of cystic lesions especially. It is demonstrated by picrosirius red dye staining combined with polarization microscopy. This method permits the evaluation of the nature of the collagen fibers in addition to their thickness. MATERIALS AND METHODS: A total of 56 histopathologically diagnosed cases comprising odontogenic follicle, dentigerous cyst, unicystic ameloblastoma, keratocystic odontogenic tumor (KCOT), multicystic/solid ameloblastoma, and ameloblastic carcinoma were taken and stained using picrosirius red stain and evaluated using a polarizing microscope. RESULTS: Collagen fibers in odontogenic follicles and dentiger-ous cysts showed predominant orange-red birefringence; fibers in unicystic ameloblastoma and KCOT showed both orange red and greenish-yellow birefringence; and fibers of multicystic/ solid ameloblastoma showed predominant greenish-yellow birefringence and ameloblastic carcinoma that showed almost complete greenish birefringence. As the biological behavior of the lesions in the spectrum studied progress toward aggressive nature, increase in immature collagen fibers is noticed. CONCLUSION: This study suggests that the nature of collagen fibers plays a pivotal role in predicting the biological behavior of odontogenic lesions. CLINICAL SIGNIFICANCE: Aggressive nature of the odontogenic lesions is determined by both the epithelium and the connective tissue components (collagen). Studying the nature and type of collagen helps in predicting its biological behavior.

Cytological Changes in Normal Oral Mucosa of Individuals with Tobacco Habits: A Cytomorphometric Study.

INTRODUCTION: Oral cancer is one of the six most common cancers in the world, and globally more than 50% of head and neck cancers occur in Asia, remarkably in India. Overall, 200,000 cases of head and neck cancers occur each year in India, among which 80,000 are oral cancers. Epidemiological and clinical studies suggest a causative role of tobacco use in the evolution of oral potentially malignant and malignant disorders. AIMS AND OBJECTIVES: The aim of the study is to evaluate independently and compare the cytological effects of smoking, tobacco chewing, and smoking in conjunction with tobacco chewing on oral mucosa by cytomorphometric analysis. MATERIALS AND METHODS: The study included a total of 120 individuals subdivided into four groups, each group with 30 individuals. Group I was tobacco smokers, group II tobacco chewers, and group III both tobacco smokers and chewers. Group IV comprised 30 individuals without tobacco habit. Smears were prepared from buccal mucosa of both the study and control groups using a cytobrush and stained using Papanicolaou staining. The cells were quantified using image analysis software. RESULTS: The results of the study showed alterations in the nuclear and cellular parameters in the study groups when compared with control groups and were statistically significant (p < 0.05). CONCLUSION: The present study explains the significance of early identification of cellular changes in individuals with tobacco habits who require early intercession even without any visible oral mucosal changes. The study emphasizes that exfoliative cytology and cytomorphometry aid as a valuable tool to evaluate the effect of tobacco on oral mucosa. CLINICAL SIGNIFICANCE: Simple noninvasive techniques like exfoliative cytology can be employed as a chairside technique and in mass screening programs for identification of cellular changes in oral mucosa of individuals with tobacco habits. Thereby, it can be used as an early diagnostic tool for identification of potentially cancerous and cancerous lesions.

Complementary and alternative medicine (CAM) use in an Italian cohort of pediatric headache patients: the tip of the iceberg.

The use of complementary alternative medicine (CAM) in paediatric populations is considerably increased, especially for pain and chronic conditions, as demonstrated by epidemiological surveys both in Europe and in the USA. In our study, CAM was used in 76 % patients of a cohort of 124 children affected by headache (age 4-16 years; 67 % female; 70 % migraine without aura, 12 % migraine with aura, 18 % tensive headache according to IHS criteria) consecutively recruited at a Pediatric Headache University Center. CAM was used as preventive treatment in 80 % cases. The main reasons for seeking CAM were: the wish of avoiding chronic use of drugs with their related side effects, the desire of an integrated approach, the reported inefficacy of conventional medicine, and a more suitable children disposition to CAM than to pharmacological compound. Female gender, younger age, migraine without aura, parents' higher educational status, maternal use of CAM and other associated chronic conditions, correlated with CAM use (p < 0.05). 73 % patients chose CAM also to treat other diseases (i.e. allergies, colitis, asthma, insomnia, muscle-scheletric disorders and dysmenorrhoea). The most assumed CAM were: herbal remedies (64 %) such as Valeriana, Ginkgo biloba, Boswellia serrata, Vitex agnus-castus, passion flower, Linden tree; vitamins/minerals supplements (40 %) with magnesium, 5-Hydroxytryptophan, vitamin B6 or B12, Multivitamin compounds; Homeopathy (47 %) with Silicea, Ignatia Amara, Pulsatilla, Aconitum, Nux Vomica, Calcarea phosphorica; physical treatment (45 %) such as Ayurvedic massage, shiatsu, osteopathy; yoga (33 %); acupuncture (11 %). CAM-often integrated with conventional care-was auto-prescribed in 30 % of the cases, suggested by non-physician in 22 %, by the General Practitioner in 24 % and by paediatrician in 24 %. Both general practitioners and neurologists were mostly unaware of their patients' CAM use. In conclusion, neurologists should inquire for CAM use and be prepared to learn about CAM therapies or to directly interact with CAM trained experts, in order to coordinate an integrative approach to health, as especially required in paediatric headache patients and their parents. Further studies are required to investigate safety and efficacy of CAM in pediatric headache, as a possible side-medicine to conventional pharmacological approach.

Salivary and Serum Interleukin-6: A Credible Marker for Predicting Oral Leukoplakia and Oral Squamous Cell Carcinoma by Enzyme-Linked Immunosorbent Assay (ELISA).

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the most prevalent subtype of oral cancer. Detecting oral potentially malignant disorders (OPMDs) in their early stages is crucial to prevent their advancement into OSCC. One of the primary factors contributing to OSCC is tobacco use, which can lead to increased production of cytokines. Among these cytokines, interleukin-6 (IL-6), an immune molecule involved in inflammation, may serve as a valuable indicator for assessing the progression of OPMDs and OSCCs. AIMS: The aim of this study is to assess the levels of IL6 in both serum and saliva using the enzyme-linked immunosorbent assay (ELISA) technique and to determine the prognostic value of these measurements in individuals with oral leukoplakia and OSCC. MATERIALS AND METHODS: The research involved 45 participants, who were categorized into three groups: OSCC (15), leukoplakia (15), and a control group consisting of healthy individuals (15). Saliva and serum samples were collected from each individual within all three groups and analyzed using the ELISA method. Subsequently, the gathered data underwent statistical analysis for evaluation. RESULTS: There were elevated levels of IL-6 in both saliva and serum among individuals with OSCC in comparison to those with leukoplakia and the healthy control group, and this difference was statistically significant. The analysis of ROC (Receiver Operating Characteristic) curves demonstrated that salivary IL-6 was a more effective indicator than serum IL-6 for detecting the advancement of OSCC. As the histological grade of differentiation increased in both OSCC and leukoplakia cases, there was a corresponding rise in salivary IL-6 levels. CONCLUSION: Both salivary and serum IL-6 levels have the potential to serve as valuable prognostic biomarkers for oral leukoplakia and OSCC which shows possible involvement of IL-6 in the development and progression of these conditions. Salivary IL-6 is a superior prognostic marker compared to serum IL-6 due to its non-invasive nature which makes it a useful tool for mass screening.

Comparison between Oblique Lumbar Interbody Fusion (OLIF) and Minimally Invasive Transforaminal Lumbar Interbody Fusion (MISTLIF) for Lumbar Spondylolisthesis.

Background: Lumbar interbody fusion has gained popularity for the treatment of spondylolisthesis in recent years. Both procedures have their own advantages and disadvantages. Objective: The aim of this study was to compare the clinical and radiological outcomes of MIS TLIF and OLIF in terms of visual analog score, Oswestry Disability Index, Intraoperative blood loss, and various other parameters. Material and Methods: This is a retrospective matched-pair comparative analysis between two groups who underwent Single level either OLIF or MISTLIF for spondylolisthesis operated from January 2017 to January 2020 at a Single institute by a Single surgeon. Results: Statistically there is no difference in various preoperative parameters between the two groups. The intraoperative blood loss is 112.5 mL in OLIF, and 144.6 mL is MISTLIF. The duration of surgery in OLIF is 4.41 h and 3.16 h in MISTLIF. The mean duration of the requirement of postoperative analgesia is 3 months after OLIF and 5 months after MISTLIF. The time taken for returning to regular activities is less in OLIF than MISTLIF. Conclusions: Although both OLIF and MISTLIF have almost equivalent outcomes, OLIF is better than MISTLIF in having lesser intraoperative blood loss and achieving better lordotic correction.

Novel Methods to Understand the Temporal Nature and Accuracy of Delivery for Insulin Infusion Pumps.

BACKGROUND: A wide suite of methods are available to evaluate delivery accuracy of insulin pumps. However, these methods do not capture any temporal information, which may be critical for design of artificial pancreas (AP) systems. We propose a novel video microscopy method to understand the delivery accuracy and temporal nature for a new durable pump under development (IFP), and a commercially available pump (Medtronic 722G, M722G). METHODS: The cannula tip of an infusion set is inserted into a graduated pipette placed under a digital microscope. A video of the delivery is captured to track the fluid meniscus, to measure volumetric delivery rate and accuracy. This was done for a programmed value of 0.5 and 1 U. A similar procedure was adopted to track linear motion of the piston rod, which actuates the reservoir plunger, for a programmed value of 10 U. RESULTS: It was observed that the commercially available pump delivers insulin in pulses of 0.05 U every two seconds. The mean absolute volumetric delivery error (MAE) for both pumps was found to be within the values reported previously. More importantly, it was found that a significant fraction of the programmed value is delivered, after completion of the planned bolus duration (IFP: 14.31% vs M722G: 9.38% for 1 U delivery). CONCLUSIONS: The methods presented in this article help understand the delivery dynamics of liquid drug delivery devices. Our results indicate that a significant fraction of insulin delivery happens after the planned bolus duration, which might be important consideration for design of AP systems.

Catalytic chameleon dendrimers.

Dendrimers with boronic ester end-groups and an iron porphyrin core were synthesized and characterized. The dendrimer termini were reversibly exchanged by the addition of appropriate diol molecules. According to molecular dynamics (MD) simulations, the exchange of termini may lead to changes in the conformational behavior of the dendrimer, specifically regarding the average position of the end groups relative to the core. The spatial steric disposition attained with different termini was shown to significantly affect epoxidation reaction activity and selectivity with various alkenes, thus allowing for an original way to control and adjust catalytic behavior under alternating environments.

Septic shock, pneumonia, and soft tissue infection due to Myroides odoratimimus: report of a case and review of Myroides infections.

The genus Myroides comprises aerobic, yellow-pigmented, non-motile, non-fermenting gram-negative rods formerly classified as Flavobacterium odoratum. Members of the genus are widely distributed in the environment, especially in water, and usually behave as low-grade opportunistic pathogens, having been found to cause urinary tract infection, endocarditis, ventriculitis, and cutaneous infections in severely immunocompromised patients. We report a case of soft tissue infection, septic shock, and pneumonia due to M. odoratimimus in an immunocompetent male. To our knowledge, this is the first description of life-threatening infection caused by this organism in an immunocompetent host. We have also reviewed the medical literature on the genus Myroides.

Evaluation of liver function in symptomatic COVID-19 patients.

CONTEXT: The coronavirus disease 2019 (COVID-19) is a viral respiratory illness which was first detected in Wuhan, Hubei Province, China. A few case studies demonstrated that 14-53% of the cases of COVID-19 reported abnormal levels of liver enzymes during disease progression. Patients with severe COVID-19 seem to have higher rates of hepatic dysfunction. AIMS: Our aim was to investigate the changes in the liver function test in COVID-19 patients admitted to hospital and its association with the severity of the disease, length of hospital stay, and outcome of patients. SETTINGS AND DESIGN: This was a cross-sectional study involving 678 COVID-19 patients, who were admitted at AIIMS, Bhopal. METHODS AND MATERIAL: The case records of 678 patients were evaluated by the research team from the Department of Medicine, AIIMS, Bhopal, and data were analyzed. All laboratory data were obtained. The liver function tests (LFT) including alanine aminotransferase, aspartate aminotransferase, and total bilirubin values were recorded, and liver dysfunction defined as any parameter having more than the upper limit of normal value. RESULTS: From April 2020 to September 2020, a total of 678 COVID-19 patients were screened, and 600 were assessed for eligibility; 78 were excluded due to either significant alcohol history or due to prior liver disease. Among the 600 patients, 265 patients (44.16%) had liver dysfunction while 335 patients (55.83%) had a normal liver function. The patients having a severe disease were more affected by liver dysfunction than the mild disease patients. The average hospital stay was more in those patients having liver dysfunction than in those patients with normal liver function. Among the patients with normal LFT on admission, 97.9% got cured while 2.1% died. Among the patients with liver dysfunction, 80.4% got cured and 19.6% died. CONCLUSIONS: Hepatic injury is common in severe COVID-19 patients, which may be caused by direct injury to the bile duct cells by a virus or indirectly by a cytokine storm. The liver function should be evaluated in all symptomatic COVID-19 patients. In patients with pre-existing liver diseases, special attention should be paid to monitoring and treatment.

Comparison of standard dose with high dose of methylprednisolone in the management of COVID-19 patients admitted in ICU.

CONTEXT: The pathological progression in severe Coronavirus Disease 2019 (COVID-19) includes an excessive and unregulated pro-inflammatory cytokine storm. Though the efficacy of corticosteroids like methylprednisolone (MPS) in severe COVID-19 is proven now, its dose and duration are not precise. AIMS: Our study aimed to compare the effect of a standard dose (SD) of MPS (60-120 mg/day) to a high dose (HD) of MPS (>120 mg/day) on the outcome of hospitalized COVID-19 patients. SETTINGS AND DESIGN: This study was a cross-sectional study. Patients admitted to AIIMS, Bhopal's intensive care unit (ICU) from July 2020 to March 2021 were enrolled in the study. METHODS AND MATERIAL: The patient's medical records were extracted from the medical record section of the hospital. The primary endpoint was the all-cause mortality during the hospital stay. The secondary endpoints were the need for mechanical ventilation, the use of vasopressors, the occurrence of acute kidney injury (AKI), and secondary infections. STATISTICAL ANALYSIS USED: Data were entered in the MS Excel spreadsheet and coded appropriately. RESULTS: Our data showed that survival, the need for mechanical ventilation, the occurrence of AKI, and secondary bacterial infection are comparable among the two groups with no significant difference. The logistic regression analysis showed that there is a slightly higher risk of death for patients with an acute respiratory distress syndrome (ARDS) receiving HD of corticosteroids compared to SD, though these results were found to be statistically non-significant. CONCLUSIONS: In hospitalized patients suffering from severe COVID-19 pneumonia, an SD of MPS is as effective as an HD of MPS in terms of reduction in mortality and need for mechanical ventilation.

Extent of multifocality with corneal manipulation in manual small incision cataract surgery with monofocal posterior chamber intraocular lens implantation.

Purpose: To compare the visual outcome in terms of multifocality in Manual Small Incision Cataract Surgery (MSICS) with and without intraoperative manipulation of corneal curvature. Methods: This was a prospective study on 80 subjects (80 eyes) who underwent MSICS with monofocal posterior chamber intraocular lens (PCIOL) implantation between January 2018 and October 2019. Intraoperative manipulation of corneal curvature using viscoelastics was performed during MSICS in 40 subjects (cases) while this intraoperative manipulation was not performed in the remaining 40 subjects (controls). Uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) were compared at day 1, 7, 30 and 180postoperatively. Results: At 1 month and 6 months of follow up, UDVA was comparable in the 2 groups. UNVA was better in cases than controls at 1 month and6 months (P < 0.001). At 6 months of follow up,76% of cases with UDVA of 6/9 or better had UNVA of N8 while only 15% of controls with UDVA of 6/9 or better had UNVA of N8 (P <0.001). Mean near add requirement to achieve a best corrected near vision (BCNV)of N6 at 6 months was significantly lesser (P =0.002) in cases (+2.05 D) compared to controls (+2.43D). Conclusion: MSICS with intra operative manipulation of corneal curvature resulted in better unaided near visual acuity compared to that without intra operative manipulation of corneal curvature, without compromising unaided distant visual acuity.

Trumpet sounds emitted by male sperm whales in the Mediterranean Sea.

Sperm whale trumpets are sounds only occasionally documented, with a well recognisable and stereotyped acoustic arrangement. This study investigated the acoustic features of the trumpets and the context in which these sounds were recorded, using acoustic data collected over 22 years, in the Pelagos Sanctuary area (North-Western Mediterranean Sea). Analysed trumpets (n = 230), recorded at the beginning of a dive after the whale fluke-up, comprised a series of acoustic units organized in short sequences. Acoustic parameters were derived for the entire trumpet and for each distinguishable unit in a trumpet. Overall, trumpet durations and their initial frequencies were higher in recordings collected when multiple whales were visually or acoustically detected in the observation area. The identity of 68 whales was assessed through photo-identification, with 29 individuals producing trumpets within and between years. The variability of the acoustic parameters appeared to be higher within the same individuals rather than between different individuals, suggesting an individual plasticity in composing and arranging units in a trumpet. Different click patterns were observed before and after the trumpets, with more complex sequences when (1) other whales were visually/acoustically detected, and (2) individuals were in suitable foraging sites (i.e., canyon areas). Trumpets were commonly followed or preceded by click patterns suited for communication, such as codas and/or slow clicks. Significant relations between the trumpet emission and the male-only long-range communication click pattern (i.e. slow clicks) emerged, supporting the hypothesis that a trumpet is a sound emitted by maturing/mature males in feeding grounds. This study provides the first evidence that trumpets were conserved in the sperm whale acoustic repertoire at the decadal timescale, persisting across years and individuals in the same area. This persistence may be functionally specific to foraging activities performed by males in a well-established feeding area.

Susceptibility of gamma-irradiated primary teeth to a cariogenic challenge: an in vitro study.

PURPOSE: This study aimed to evaluate whether radiotherapy with gamma radiation changes the susceptibility of primary teeth to a cariogenic challenge. METHODS: Specimens of primary teeth (n = 18) were subjected to gamma radiation simulating the radiotherapy treatment, and 18 specimens were used as control group. A microbiological model of caries induction by S. mutans was used to evaluate the susceptibility of these irradiated specimens to the caries development. The depth, area and volume of caries lesion formed were evaluated using microcomputer tomography analysis (µ-CT) and changes occurring on the enamel surface were evaluated using scanning electron microscopy (SEM). Data of the lesion depth, lesion area and volume were submitted to independent t test with a 5% of significance limit. RESULTS: The lesion depth and the area of caries in the irradiated group (196.61 ± 60.41 µm and 564.52 ± 343.37 µm2, respectively) were significantly higher (p = 0.02 and p = 0.03, respectively) than those in the nonirradiated group (151.70 ± 32.16 µm and 386.64 ± 169.75 µm2, respectively). However, the lesion volume did not differ (p = 0.15) between the groups (7797.89 ± 3675.69 µm3 for irradiated and 6509.03 ± 2902.65 µm3 for nonirradiated group). The SEM images show greater enamel breakdown in the group of irradiated specimens. CONCLUSION: The present study results reveal that the gamma radiation protocol used for cancer treatment renders primary teeth more susceptible to a cariogenic challenge.

Salivary Tumour Necrosis Factor-α as a Biomarker in Oral Leukoplakia and Oral Squamous Cell Carcinoma.

Background: Oral cancer is one of the life threatening disease which requires an availability of a biomarker for its early detection and also for effective treatment strategies. The current study is done to evaluate the efficacy of one such biomarker i.e. TNF- α as an indicator for oral precancer and oral cancer. Objectives: To evaluate the efficacy of Tumour necrosis factor - alpha (TNF)-α as a salivary biomarker in histopathologically diagnosed cases of oral leukoplakia and Oral squamous cell carcinoma. To correlate the levels of TNF- α with varying histologic grading in Oral Squamous Cell Carcinoma and dysplasia grading in Oral leukoplakia or Hyperkeratosis. Materials and Methods: The study group included 90 subjects that were divided into three groups. OSCC (n=30), leukoplakia (n=30) and controls (n=30). Cases were selected based on inclusion and exclusion criteria of the study. Salivary samples were then collected from all three groups. Salivary levels of TNF-α were estimated using Enzyme Linked Immunosorbent Assay (ELISA). The data on concentration gradients obtained were subjected to appropriate statistical analysis. Results: The results of the present study demonstrated higher levels of salivary TNF-α in individuals with OSCC compared to leukoplakia and healthy control subjects with a high level of statistical significance. ROC curve analysis along with diagnostic parameter calculation also revealed that salivary TNF-α to be a better medium for detecting OSCC. There is also an increase in the salivary TNF-α levels with increase in the histological grade of differentiation in OSCC as well as leukoplakia. Conclusion: The present study concludes that salivary TNF ­ α can be used as a prognostic biomarker of OSCC. In view of the elevated levels of TNF ­ α in saliva of individuals with severe dysplasia, it can also be used to monitor the malignant transformation to leukoplakia to OSCC.

Eosinophils: An imperative histopathological prognostic indicator for oral squamous cell carcinoma.

BACKGROUND: Inflammation in tumor microenvironment assists in both promotion and growth of tumor. Tumor-associated tissue eosinophilia (TATE) is the term used when eosinophils are observed in a tumor tissue with inflammatory infiltrate. Although carcinogenesis with inflammation is one of the important hallmarks, the exact role of eosinophils remains unclear. Various studies on oral squamous cell carcinoma (OSCC) that focused on eosinophils reported both favorable and unfavorable prognosis in cancer tissue, because of which the exact function of eosinophils still remains uncertain. AIMS AND OBJECTIVES: The present study aims at identifying the role of TATE in OSCC and in malignant transformation of oral epithelial dysplasia (OED). MATERIALS AND METHODS: The study includes 70 samples that divided into two groups, of which 50 histopathologically proven cases of different grades of OSCC and 20 cases of OED (oral leukoplakia). Congo red stain was used to stain the tissue sections. Each slide was viewed under high power in 10 consecutive microscopic fields for counting of eosinophils. RESULTS: Statistical analysis of values obtained was done using ANOVA, unpaired t-test and Mann-Whitney test. The results were statistically significant (P < 0.05) with a mean total eosinophil count of 2.12 in OED and 4.31 in OSCC. CONCLUSION: The present study showed higher eosinophil counts in OSCC when compared to dysplasia which should prompt for a thorough evaluation of tumor front for invasiveness. Therefore, tissue eosinophil count may be used as an adjunct to predict the malignant transformation of dysplastic lesions to OSCC.