Role of Interventional Radiology (IR) in vascular emergencies among cirrhotic patients.

Gastrointestinal hemorrhage remains one of the most common causes of morbidity and mortality among patients with liver cirrhosis. Mostly, these patients bleed from the gastroesophageal varices. However, nonvariceal bleeding is also more likely to occur in these patients. Because of frequent co-existing coagulopathy, cirrhotics are more prone to bleed from a minor vascular injury while performing percutaneous interventions. Ultrasound-guided bedside vascular access is an essential procedure in liver critical care units. Transjugular portosystemic shunts (TIPS) with/without variceal embolization is a life-saving measure in patients with refractory variceal bleeding. Whenever feasible, balloon-assisted retrograde transvenous obliteration (BRTO) is an alternative to TIPS in managing gastric variceal bleeding, but without a risk of hepatic encephalopathy. In cases of failed or unfeasible endotherapy, transarterial embolization using various embolic agents remains the cornerstone therapy in patients with nonvariceal bleeding such as ruptured hepatocellular carcinoma, gastroduodenal ulcer bleeding, and procedure-related hemorrhagic complications. Among various embolic agents, N-butyl cyanoacrylate (NBCA) enables better vascular occlusion in cirrhotics, even in coagulopathy, making it a more suitable embolic agent in an expert hand. This article briefly entails the different interventional radiological procedures in vascular emergencies among patients with liver cirrhosis.

Ewing's sarcoma masquerading as an odontogenic infection.

ABSTRACT: Ewing's sarcoma (ES) is a small, blue, malignant, round cell tumor of unknown origin. ES is the fourth most common malignant bone tumor, whereas among children, it is found to be the second most common primary malignant bone tumor after osteosarcoma. Swelling is usually the first clinical presentation, followed by pain. ES is an aggressive tumor showing rapid growth and metastasis with complex diagnosis. Because mandibular involvement is rare, it can be misdiagnosed as an odontogenic infection/tumor. We report an unusual case of ES in a 13-year-old female treated for an odontogenic infection before a diagnosis of ES was finally made to make the clinicians aware of this rare entity. Emphasis is also given that ES and odontogenic infections/tumors can masquerade each other with delays in diagnosis and the possibility of devastating results.

Comedone Extractor with Multiple Variable Sized Holes for Mass Comedone Extraction.

Conventional comedone extractor has only one or two holes of fixed or variable sizes. This conventional extractor is not suitable for mass comedone extraction and that too of variable sizes. We tried to made an attempt to overcome this problem.

Imaging findings of orofacial cysticercosis: report of 5 cases with review of literature.

Cysticercosis, a fatal disease of parasitic aetiology seen in humans, is caused by ingestion of larvae of Taenia solium in form of raw or poorly cooked pork. Commonly seen in developing countries, it affects the brain, muscle, lungs, heart and liver and is rarely found in the maxillofacial region. Sometimes, the only evidence of cysticercosis could be the cystic swellings or nodules in the maxillofacial region. Such solitary clinical presentation can be diagnosed early with the aid of ultrasound (USG) and Magnetic resonance imaging (MRI). Here, we present 5 cases of intramuscular cysticercosis of Orofacial region which were initially diagnosed on ultrasonography and later confirmed by MRI and aspiration cytology. We have conducted a systematic review of PubMed Literature for Intramuscular cysticercosis of orofacial region and highlighted key imaging findings from 18 cases retrieved. Through this case series, we highlight the USG and MRI imaging features of intramuscular cysticercosis which are characteristic and diagnostic of the condition.

Diagnosing rare intraductal biliary neoplasms - Intraductal papillary neoplasm of the bile duct: A case report with typical imaging findings.

Intraductal papillary neoplasm of the bile duct (IPN-B) is a rare preinvasive intraductal pathology of the biliary tract. It should be differentiated from other more common benign or malignant causes of biliary obstruction and dilatation such as calculi or cholangiocarcinoma because the management and prognosis of this condition differs significantly. This case report describes a case of IPN-B in a 45-year-old female patient who presented with non-specific complaints of chronic abdominal pain without jaundice for three months.

Comparative efficacy of topical aloe vera and low-level laser therapy in the management of oral lichen planus: a randomized clinical trial.

This randomized clinical trial aimed to compare the efficacy of topical aloe vera with low-level laser therapy in patients with oral lichen planus (OLP). A randomized, parallel arm, single-blind study comprising of 60 patients with OLP was randomly divided into two groups. Group A was given topical aloe vera extract gel applied thrice daily for 2 months, and group B was given low-level laser therapy (LLLT) at 980 nm twice weekly for 2 months. Both groups were followed up for 9 months. Patients were assessed for various parameters according to the Escudier scale at baseline, after treatment at 9 months. Results were assessed using the McNemar-Bowker test and the Mann-Whitney U test. Both individual groups showed significant (p < 0.05) results at the end of the treatment period (0-2 months) and the follow-up period (2-7 months). Intergroup comparison showed significant results in the laser group (reduction of VAS by 44.1%, site score by 24.6%, and activity score by 50%) as compared with the aloe vera group (reduction of VAS by 26.7%, site score by 9.2%, and the activity score by 26%) in the treatment period. In the follow-up period, both groups showed insignificant differences in comparison to each other. Within the limitations of the study, LLLT was more effective as compared with topical aloe vera in managing oral lichen planus during the active treatment time, while both were equally effective during the follow-up period. The clinical study was registered under the Clinical Trials Registry India with the registration number CTRI/2018/04/013147.

Novel Treatment Approach of Oral Submucous Fibrosis in a 6-year-old Girl: A Case Report.

BACKGROUND: Oral submucous fibrosis is characterized by stiffness of oral mucosa, blanching and functional limitation, and areca nut predisposition is considered to be one of the main etiological factors. In recent years, there is an increasing prevalence of OSMF in the Indian subcontinent owing to increased consumption of smokeless tobacco products. Very few cases of pediatric OSMF are reported in PubMed literature. Oral submucous fibrosis has a malignant transformation rate of 7-13% and hence, it is important to intervene at an appropriate stage and manage it well in time. AIM AND OBJECTIVE: To report a case of oral submucous fibrosis (OSMF) in a 6-year-old Indian girl along with its management and follow-up. CASE DESCRIPTION: A 6-year-old girl of Indian origin was diagnosed with OSMF and we have used sesame oil pulling as a novel treatment approach and observed good results with long-term follow-up. We have also reviewed PubMed literature for cases of pediatric OSMF reported till date. CONCLUSION: A timely diagnosis and intervention becomes necessary in pediatric OSMF to improve oral function and prevent malignant transformation. CLINICAL SIGNIFICANCE: It is important to report oral potentially malignant disorder (OPMD) cases in pediatric patients and create awareness through health education programs so that parents and children know about the ill effects of consuming tobacco products. HOW TO CITE THIS ARTICLE: Gupta S, Gupta S, Chaudhary C, et al. Novel Treatment Approach of Oral Submucous Fibrosis in a 6-year-old Girl: A Case Report. Int J Clin Pediatr Dent 2021;14(4):575-579.

A Rare Case of Peripheral Ossifying Fibroma in an Infant.

Peripheral ossifying fibroma (POF) associated with natal/neonatal teeth is extremely rare. In general, POF occurs as a soft-tissue gingival nodule occurring in young adults. We report an unusual and a rare case in a 5-month-old male child who had two, localized, soft-tissue growth over the mandibular anterior alveolar ridge. History revealed the presence of natal teeth in the same mandibular anterior region, which exfoliated at the age of 2 months. Intraoral periapical radiograph showed soft tissue density with evidence of calcifications that also corroborated with the histopathological finding of masses of mineralized areas. Excision of the lesions followed by histopathological examination proved the final diagnosis of POF. Inspite of being a benign reactive lesion, a high recurrence rate has been reported. Such lesions require long-term follow-up subsequent to excision with histopathological examination due to a high recurrence rate.

Homology modeling, structural insights and in-silico screening for selective inhibitors of mycobacterial CysE.

Tuberculosis posses a major threat for health practitioners due to lengthy treatment regimen, increase in the drug-resistant strains of Mycobacterium tuberculosis (M. tb) and unavailability of drugs for its persistent form. Therefore, there is an urgent need for discovery of new and improved anti-tubercular drugs. In M. tb, the two step de novo biosynthesis of L-cysteine, an essential metabolic pathway is reported to be up-regulated in the persistent phase of the organism, involves two enzymes CysE and CysK. Although, structural insights for rational drug discovery are available for the later, not much information is known for the former. This study proposes a 3-dimensional model of M. tb CysE followed by in-silico screening of 67,030 anti-tuberculosis bioactive compounds. Subsequently, post-processing of 1000 best hits was carried out and top 200 compounds thus obtained were docked into the active site cleft of E. coli homologue as a control, but revealed unexpected results. Differences in the active site architectures and comparative analysis of molecular electrostatic potentials between the two CysEs provide molecular basis for the compounds C1, C3, C4 and C7 exhibiting preferential binding for M. tb CysE. In addition, shorter N-terminus along with positive and irregular trimeric base of M. tb CysE indicates its biological assembly as trimer. Based on mapping of residues involved in cysteine sensitivity on to the model structure of M. tb CysE, it is hypothesized that feedback inhibition of this homologue by cysteine may be affected.Communicated by Ramaswamy H. Sarma.

Using Hypodermic Needle as Suture Needle in Emergency.

Sometimes, suture thread detaches from needle while suturing. This leads to wastage of left over thread and we have to repeat whole process of suturing as the extra suture needles are not easily available. The present article highlights the use of hypodermic needle as suture needle in such emergencies.

Cemento-osseous dysplasia: Clinicopathological spectrum of 10 cases analyzed in a tertiary dental institute.

BACKGROUND: Cemento-osseous dysplasia (COD) is a distinct entity, which is confined to the tooth-bearing areas of the jaws or edentulous alveolar processes. AIMS: This study analyzes the demographic, clinical, radiographic and histopathological features of COD. MATERIALS AND METHODS: Archival data from 2013 to 2017 present in the Department of Oral Pathology were retrieved. Clinicopathological and radiological features of all the cases which had been previously diagnosed as COD were analyzed in detail. RESULTS: In the present study, 10 cases of COD were analyzed (1 periapical, 6 florid and 3 focal). Equal sex predilection was observed. The mean age in females and males was 42.6 years (22-64 years) and 28.6 years (17-36 years), respectively. Bony expansion was seen frequently, but pain was not a common feature. Mandible was affected almost twice as frequently as maxilla and posterior region was affected more than anterior region. Most cases showed mixed radiopaque and radiolucent lesion (5/10) and peripheral radiolucent rim (9/10) on radiographic examination. Histopathological features included the presence of curvilinear trabeculae (4/10), sheets of compact bone (3/10) or both (3/10). Foci of mineralization in form of ossicles or cementicles were noted in 5 out of 10 cases. CONCLUSION: COD is a nonneoplastic process usually confined to the tooth-bearing areas of the jaws or edentulous alveolar processes. Depending on the location and extent, it can be either focal/periapical/florid variant. Histopathological features of COD can overlap with other fibro-osseous lesions. Hence, the correlation of clinical, radiological and histopathological features is of paramount importance in the accurate diagnosis of COD.

Microcephalic osteodyplastic primordial dwarfism type II: case report with unique oral findings and a new mutation in the pericentrin gene.

OBJECTIVE: Microcephalic osteodysplastic dwarfism (MOPD) type II (OMIM 210720) is a rare autosomal recessive form of primordial dwarfism, characterized by intrauterine and postnatal growth restriction, microcephaly, distinctive facial features, and osteodysplastic skeletal changes. The dental literature describing the oral manifestations of this syndrome is scarce. STUDY DESIGN: The aim of this article is to report the case of an 8-year-old male of Indian origin with MOPD type II and to describe his oral and dental manifestations. Genetic analysis was performed to confirm the diagnosis. RESULTS: The patient presented with interesting dental findings, including oligodontia, enamel hypoplasia, early exfoliation of primary dentition, accelerated eruption of permanent teeth with generalized grade II mobility, histopathologic features suggestive of dentin dysplasia, and a new mutation in the Pericentrin gene, which has not been documented earlier. CONCLUSIONS: This is the first report from India of a case with this syndrome. The article presents various dentomaxillofacial features that have not been documented in dental literature earlier with sufficient evidence.

Clinicoradiologic follow up of cherubism with aggressive characteristics: a series of 3 cases.

Cherubism is a rare autosomal dominant disorder characterized by replacement of bone with fibrous tissue containing multinucleated giant cells. It manifests as bilateral mandibular and/or maxillary enlargement. The 2017 World Health Organization classification lists cherubism as a giant cell lesion of the jaws, distinct from fibro-osseous disorders. We discuss 3 cases of familial cherubism having aggressive characteristics and present clinicoradiologic evaluations of the lesions over 12, 18, and 1.5 years, respectively. Follow-up was observational, without active intervention. Analysis of the lesions for change in size and functional impairments was correlated with periodic imaging. All patients are currently being monitored. The outcome in 2 cases has been excellent without intervention, but 1 case had extensive involvement of the jaws and involvement of the condyle and orbit. A secondary giant cell lesion involved the palate in one patient's mother, who had had cherubic lesions in childhood.

Gingival manifestations of tuberculosis in pediatric patients: series of 4 cases.

OBJECTIVE: The aim of the study was to evaluate the gingival manifestations of tuberculosis (TB) in the oral cavity in pediatric patients. STUDY DESIGN: Four pediatric patients were enrolled in the study. Clinical symptoms, auxiliary examinations, treatments, and outcomes were recorded and analyzed. Four pediatric patients who presented with atypical gingival lesions were thoroughly examined for local and systemic signs and symptoms, and a detailed history was obtained. All relevant investigations led to a definitive diagnosis of oral tuberculous lesions. On the basis of the final diagnosis, antitubercular therapy (ATT) was started for all the pediatric patients, and outcomes were measured. RESULTS: All 4 patients responded very well to the treatment, with complete resolution of the lesions within 6 months after the initiation of ATT. CONCLUSIONS: Health care professionals should rule out TB as one of the differential diagnoses in pediatric patients with atypical gingival lesions. ATT is strongly recommended for the treatment of oral TB to achieve good clinical outcomes. Rapid molecular tests based on nucleic amplification should be utilized for the diagnosis of TB in children and also for extrapulmonary TB because they are much faster and reliable compared with conventional methods.

Comparison of therapeutic response of lycopene and curcumin in oral submucous fibrosis: A randomized controlled trial.

OBJECTIVES: To evaluate and compare the therapeutic response of lycopene and curcumin with placebo in patients suffering from oral submucous fibrosis (OSMF) and to correlate the habit variables of smoked and smokeless tobacco products in OSMF. METHODS: A randomized placebo-controlled parallel clinical study was conducted on ninety OSMF patients, who were divided into three treatment groups using computer-generated randomization. Group A patients (n = 30) were given curcumin tablet (300 mg) twice daily, Group B patients (n = 30) received lycopene capsules (8 mg) twice daily, and for Group C (n = 30), placebo capsules were given once daily for a period of six months. Both the participant and outcome assessor were blinded. Pre- and post-treatment comparison of mouth opening, burning sensation, tongue protrusion, and cheek flexibility was analyzed at periodic follow-up of 9 months. RESULTS: The overall improvement in mouth opening, burning sensation, tongue protrusion, and cheek flexibility was 3.9 ± 4.9 mm, 4.8 ± 2.6, 5.0 ± 7.2 mm, & 0.36 ± 0.71 mm, respectively, for curcumin and 4.1 ± 4.2 mm, 5.0 ± 2.3, 2.4 ± 3.5 mm, & 0.66 ± 0.80 mm, respectively, for lycopene with the p value <0.05. CONCLUSION: Statistically significant improvement in clinical findings was observed in both curcumin and lycopene treatment groups in comparison with placebo. However, the therapeutic efficacy of curcumin and lycopene was found to be almost equal in OSMF patients.

Sarcomas of the Oral and Maxillofacial Region: Analysis of 26 Cases with Emphasis on Diagnostic Challenges.

Sarcomas of the Oral and Maxillofacial Region (SOMR) are rare lesions which pose diagnostic and management challenges. We analyzed 26 cases of SOMR with respect to clinical presentation, histopathological subtype, treatment modalities, recurrence, and treatment outcome. In our series, Osteosarcoma (OS) was the most common type of sarcoma (7 cases), followed by 5 cases of Ewing's Sarcoma (ES), 3 cases each of Chondrosarcoma (CS) and Leiomyosarcoma (LMS), 2 cases each of Malignant Peripheral Nerve Sheath Tumor (MPNST), Pleomorphic Undifferentiated Sarcoma (PUS), Myeloid Sarcoma (MS)and Rhabdomyosarcoma (RMS). Surgery was the primary treatment modality in most cases and was combined with adjuvant chemo/ radiotherapy in few cases. 24 of the 26 cases were followed up for an average period of 40.67 months. Adverse disease outcomes like recurrence were seen in 2 cases whereas death due to the disease was reported in 7 cases. In view of the diagnostic challenges faced in SOMRs, it appears practical to stress on the underlying genetic aspects of the disease process rather than histological subtyping to improve disease outcome.

Central Osteoma of Maxilla Associated with an Impacted Tooth: Report of a Rare Case with Literature Review.

Osteomas are benign osteogenic neoplasms caused by proliferation of mature compact or cancellous bone. Clinically they may be classified as peripheral, central or extraskeletal. Osteomas usually involve the craniofacial region with mandible being the most common site. Central osteoma of the jaws is a very rare entity with only 13 cases reported in the literature till date of which only five cases occurred in the maxilla. Here we present a case of a large central osteoma of anterior maxilla associated with an impacted tooth, the first of its kind and a review of literature.

Constitutive activation and overexpression of NF-κB/c-Rel in conjunction with p50 contribute to aggressive tongue tumorigenesis.

Tongue squamous cell carcinoma (TSCC) is a most aggressive head and neck cancer often associated with a poor survival rate. Yet, it always shows better prognosis in presence of HPV16 infection. NF-κB plays a pivotal role in carcinogenesis and chemo-radio resistance of cancer but its role in tongue cancer is not yet explored. In this study, a total of hundred tongue tissue biopsies comprising precancer, cancer and adjacent normal controls including two tongue cancer cell lines (HPV+/-ve) were employed to examine expression and transactivation of NF-κB proteins, their silencing by siRNA and invasion assays to understand their contributions in tongue carcinogenesis. An exclusive prevalence (28%) of HR-HPV type 16 was observed mainly in well differentiated tumors (78.5%). Increased DNA binding activity and differential expression of NF-κB proteins was observed with p50 and c-Rel being the two major DNA binding partners forming the functional NF-κB complex that increased as a function of severity of lesions in both HPV+/-ve tumors but selective participation of p65 in HPV16+ve TSCCs induced well differentiation of tumors resulting in better prognosis. siRNA treatment against c-Rel or Fra-2 led to upregulation of p27 but strong inhibition of c-Rel, c-Jun, c-myc, HPVE6/E7 and Fra-2 which is exclusively overexpressed in HPV-ve aggressive tumors. In conclusion, selective participation of c-Rel with p50 that in cross-talk with AP-1/Fra-2 induced poor differentiation and aggressive tumorigenesis mainly in HPV-ve smokers while HPV infection induced expression of p65 and p27 leading to well differentiation and better prognosis preferably in non-smoking TSCC patients.