Fabrication of a Low Cost Superhydrophobic Substrate for Surface Enhanced Laser-Induced Breakdown Spectroscopy and Its Utility through Identification of Electrolyte Variation for Oral Cancer Detection.

Ultratrace elemental detections from a limited volume of samples can offer significant benefits in biomedical fields. However, it can be challenging to concentrate the particles being analyzed in a small area to improve the accuracy of detection. Ring-like deposits on the edges of colloidal droplets are a vexing problem in many applications. Herein, we report ultratrace elemental detection using a superhydrophobic surface-enhanced laser-induced breakdown spectroscopy (SELIBS) substrate fabricated by laser ablation followed by a soft lithography technique. In this work, the SELIBS spectra on a superhydrophobic polydimethylsiloxane (PDMS) substrate replicated from a laser-patterned master Teflon substrate are investigated. This work highlights the application of this newly created superhydrophobic substrate for detecting trace elements in body fluids using SELIBS. The developed PDMS substrate was successfully adopted to investigate the electrolyte variation in serum samples of oral cancer patients and normal volunteers. Principal component analysis (PCA) and match-no-match analysis were used to distinguish the elemental variation in cancer and control groups.

Elemental Composition of Betel Leaves Using a Novel Optical Spectroscopic Technique.

Objective: Assess trace elements in betel leaves and slaked lime from different regions of Karnataka, India using Laser Induced Breakdown Spectroscopy (LIBS). Materials and Method: Betel leaves from six different regions of Karnataka were obtained and named (for the purpose of the study) BL1, BL2, BL3, BL4, BL5, and BL6 and they were sun-dried. A single tube of slaked lime was obtained from the local 'paan' shop. Each dried leaf and a single blob of slaked lime was subjected to elemental analysis using Laser-induced breakdown spectroscopy. Results: A ten-trial experiment was carried out in all six leaves and a blob of the slaked lime. The National Institute of Standards and Technology (NIST) database was used to assess the emission lines. The elements that were predominantly present in all six betel leaves from different regions of Karnataka are calcium, copper, and iron. Slaked lime showed only the presence of calcium. Conclusion: It is widely accepted that the consumption of betel quid causes various changes in the oral mucosa including oral potentially malignant disorders (OPMDs) and oral cancer. It is important to analyze each component of betel quid to understand the disease progression. Copper is found to be relatively higher in betel leaves, and it is known that copper-induced fibrogenesis via the lysyl oxidase pathway in oral submucous fibrosis.

Can Nurses' Training and Documentation Audit Improve the Oral Care Practice among Patients Receiving Cancer Treatment? Results from the Pretest-Post-Pest Study.

BACKGROUND: Oral complications arising out of radiation therapy and chemotherapy significantly affect the oral health status of patients leading to severe distress. Poor oral health can impair nutritional intake and patient recovery. Trained nurses lack knowledge of oral care of patients receiving cancer treatment. PURPOSE: The study is aimed at training the nurses and conducting a documentation audit to assess the effect of the training on their clinical practice.  Methods: A quantitative research approach was adopted using one group pretest-post-test design to train 72 nurses on oral care of cancer patients working in radiation oncology wards of a tertiary care setting in the southern part of India. After the training program, 80 head and neck cancer patient records were audited to monitor the implementation of oral care. RESULTS: After completing the training program, the knowledge score increased to 13.54 with a mean difference of 4.15 at a p-value <0.001, which indicates that the training was effective, resulting in a gain in knowledge scores. Nurses reported usage of evidence-based intervention, and patient education materials helped them in the clinical practice and a few barriers to oral care practice were identified while implementing the oral care i.e increased frequency of oral care, increased documentation, and time issues. There was poor adherence to the implementation of oral care for cancer patients after the training program, as monitored by a documentation audit. CONCLUSION: Capacity building of the nurses in providing effective oral care of cancer patients will help in improving the standards of cancer nursing practice. An implementation audit of the records would help check adherence to the new oral care practice. A hospital-instituted protocol can result in the effective implementation of the practice change rather than a researcher-introduced protocol.

Evaluation of Malnutrition and Quality of Life in Patients Treated for Oral and Oropharyngeal Cancer.

BACKGROUND: Oral and oropharyngeal cancer is a debilitating disease with high morbidity and mortality. Depending on the site and extent of the involvement of the cancer and the type of treatment modality, these patients can develop pain, trismus, xerostomia, dysphagia, and taste disturbances, compromising them socially and nutritionally. The aim of the study was to evaluate malnutrition and quality of life in patients treated for oral and oropharyngeal cancer. Methodology. A cross-sectional study was conducted which included 97 patients treated for oral and oropharyngeal cancer. The quality of life of the selected patients was assessed by using a validated European Organization for the Research and Treatment of Cancer's Quality of Life Questionnaire, Head and Neck and Mandibular Function Impairment Questionnaire. Pre- and posttreatment weight of the patients were assessed, and weight loss of ≥10% of pretreatment weight was considered as malnutrition. The chi-square test was used to correlate the symptoms with the quality of life. A paired t test was used to assess the differences in weight before and after treatment, and a p value of <0.005 was considered as significant. RESULTS: The most commonly reported symptoms were xerostomia (93.81%), pain (81.44%), and dysphagia (76.3%). A total of 40.2% of the individuals in the study had malnutrition. Malnutrition was comparatively lower in the group who had nutritional supplements. CONCLUSION: The quality of life in patients treated for oral and oropharyngeal cancer deteriorates immediately after the treatment; however, it significantly improves over time.

Morphometric and Volumetric Measurements of Orbit With Cone-Beam Computed Tomography.

PURPOSE: The purpose of this study was to determine cone-beam computed tomography (CBCT) as a tool for measuring morphometric and volumetric measurements of the orbit. Also, to assess gender and age variations and compare traditional methods of measurements in dry-skull, cadaveric, and other imaging modalities. PATIENTS AND METHODS: Morphometric and volumetric values of 98 orbits (49 subjects, 21 men/28 women) were measured using CBCT. Their mean and standard deviation were measured and analyzed. The gender and age variability older and younger than 40 years were evaluated. They were compared with other dry-skull and imaging studies done among different populations. RESULTS: CBCT could accurately measure the various morphometric and volumetric parameters of the orbit. From the reference point infraorbital foramen (I) to lacrimal fossa (F1), inferior orbital fissure (F2), inferior orbital rim (F3), and the optic canal (F4) were (in mm) (mean ± SD) 22.88 ± 1.08, 32.53 ± 0.88, 7.44 ± 0.71, and 51.45 ± 1.28, respectively. From the reference point, superior orbital notch/foramen (S) to superior orbital fissure (S1), lacrimal fossa (S2), and the optic canal (S3) were 49.29 ± 2.1, 26.39 ± 1.58, and 46.82 ± 0.88, respectively. From the reference point frontozygomatic suture (L) to lacrimal fossa (L1), superior orbital fissure (L2), the optic canal (L3), and inferior orbital fissure (L4) were 18.19 ± 0.88, 39.91 ± 1.44, 47.63 ± 1.11, and 35.19 ± 1.02, respectively. Orbital volume was found to show a significant difference between older and younger than 40 years of age, though not significant compared between men and women. CONCLUSION: CBCT is a viable tool for morphometric and volumetric measurements of the orbit and other orocraniofacial structures. It can also assess age and gender variability. The low cost, high accuracy, low radiation, and ease of use can help in reproducibility among the different living populations.

Patterns of Tobacco Use and its Relation to Oral Precancers and Cancers among Individuals Visiting a Tertiary Hospital in South India.

AIM: The aim of this study was to evaluate the use of tobacco and its association with oral precancers and cancers. MATERIALS AND METHODS: Medical records of 1,007 individuals were assessed for the patterns of tobacco abuse and the presence of tobacco-related oral mucosal alterations. RESULTS: This study comprised 1,007 individuals (M:F: 95.4%:4.6%). In the cohort, 60.1% had smoking habit and 56.1% had smokeless habit. Of the bidi smokers, 18.2% developed carcinoma, 14.3% developed leukoplakia, which is statistically significant (p < 0.001). A logistic regression analysis of the development of oral submucous fibrosis (OSMF) shows that habit of smokeless forms of tobacco has an odds ratio (OR) of 18+ when compared with smoking. Combination of bidi and gutkha had 12.3 times higher risk of developing oral cancer and 4.4 times risk of developing leukoplakia. A total of 33.3% betel quid and gutkha chewers presented with tobacco pouch keratosis, which is statistically significant. CONCLUSION: Smoked and smokeless forms of tobacco were equally popular among the study population. The packeted form of smokeless tobacco (gutkha) was more prevalent. Oral submucous fibrosis was more common than leukoplakia, and oral cancer developed more frequently in elderly men smoking bidis. CLINICAL SIGNIFICANCE: This study throws light on the fact that the use of both smoke and smokeless forms of tobacco is still prevalent, and the use of gutkha was most prevalent. These findings will help tobacco cessation and counseling centers to focus their effort in motivating people to stop gutkha chewing habit. This also brings to the forefront the need to create better treatment strategies to manage OSMF.

Oral Care Protocol for Chemotherapy- and Radiation Therapy-Induced Oral Complications in Cancer Patients: Study Protocol.

OBJECTIVE: The purpose of this study is to describe a randomized control trial protocol that assesses the effectiveness of an oral care protocol on chemotherapy- and radiation therapy-induced oral complications in cancer patients. METHODS: This study is a randomized, outcome assessor blinded study. For Phase I training phase, one group pretest-posttest design will be implemented for training the staff nurses on oral care in cancer patients and for Phase II Intervention Phase, randomized clinical trial will be used to determine the effectiveness of oral care protocol. Twenty-five staff nurses working in radiation oncology areas hospital will be trained about oral care in cancer patients. Seventy newly diagnosed patients with head and neck cancer admitted to the oncology wards of a tertiary care hospital in South India will be enrolled. Patients will be randomly allotted to a control and intervention group. The primary outcome variables are oral complications and oral health assessment. RESULTS: The results of the preliminary survey conducted among 158 staff nurses showed that 81 (51.3%) of the staff nurses had poor knowledge regarding oral care of cancer patients and majority 128 (81.0%) of them suggested for training in the specific area of oral care of cancer patients. A pilot study conducted by the principal investigator to determine the feasibility of the study among 9 participants (4 experimental and 5 control) revealed that there was slight difference found in the incidence of oral complications among the group in relation to weeks of assessment. CONCLUSIONS: The present study may give data regarding the occurrence of oral complications in head and neck cancer patients, and even, it can enlighten on the effectiveness of oral care protocol on oral complications. If this protocol is found effective, then this protocol can be made part of daily nursing care to improve the patient outcome.

Oral care in cancer nursing: Practice and barriers.

BACKGROUND: Oral health awareness and oral care are crucial aspects of oncology nursing practice. However, very few studies concentrate on the oral care of cancer patients undergoing cancer treatment and nursing practice in the Indian subcontinent scenario/situation. Most of the published studies have been conducted in the Western and European countries. AIMS: This study aimed to determine the nurses' practice and barriers regarding oral care in cancer patients undergoing chemotherapy and radiation therapy. MATERIALS AND METHODS: A cross-sectional descriptive survey was conducted among 158 staff nurses working in oncology-related areas from four different hospitals of Dakshina Kannada district and Udupi district of Karnataka state, India. STATISTICAL ANALYSIS: Descriptive and inferential statistics was used by using SPSS 16 version. RESULTS: More than half of respondents [54 (34.2%)] did not perform oral care as a part of routine duties. Maintenance of various records, lack of manpower, and lack of standard operating procedures were major barriers in providing oral care. Documentation audit revealed that nurses recorded oral care in the chart only when order was present in the care sheet, but oral problem assessment was not recorded at all. In all four hospitals surveyed, there was no protocol specifically designed for oral care of cancer patients. CONCLUSION: Nurses expressed that oral care in cancer patients was one of the most ignored aspect in oncology nursing. Our result highlights the need to develop evidence-based oral care intervention protocol and motivate staff nurses to attend continuing nursing educations regularly to keep themselves abreast of the latest trends in order to render comprehensive care to the patients.

Detection of human papilloma virus in potentially malignant and malignant lesions of the oral cavity and a study of associated risk factors.

BACKGROUND: Squamous cell carcinoma of the head and neck is the 6th most frequently occurring cancer worldwide, with over 400,000 cases projected annually. Multiple factors such as tobacco, alcohol, irradiation, virus, and chronic irritants are involved in the development of oral squamous cell carcinomas (OSCCs). The most important risk factors are chronic exposure to tobacco and alcohol. Although the evidence that implicates virus is increasing, particularly (human papillomavirus [HPV]), in the carcinogenesis process, the role of virus is not well established. AIM AND OBJECTIVE: This study is designed to assess the presence of HPV in potentially malignant and malignant lesions of the oral cavity as well as to correlate the presence of HPV with addictive habits and histopathological grading of the disease. MATERIALS AND METHODS: Biopsy samples of OSCC and potentially malignant lesions were obtained and 3, 5 µm thickness sections were cut using a microtome. The sections were collected using a sterile brush and transferred to an Eppendorf tube. DNA extraction and polymerase chain reaction for the detection of HPV were done. RESULTS AND CONCLUSION: The association between histopathological grading and presence of HPV was assessed using Chi-square test and the values thus obtained were found to be statistically significant. HPV was more predominantly seen in well-differentiated carcinomas and moderately differentiated carcinomas as compared to poorly differentiated carcinomas.

Rebamipide to Manage Stomatopyrosis in Oral Submucous Fibrosis.

INTRODUCTION: Oral submucous fibrosis (OSF) causes progressive debilitating symptoms, such as oral burning sensation (stomatopyrosis) and limited mouth opening. The standard of care (SOC) protocol includes habit cessation, intralesional steroid and hyaluronidase injections, and mouth opening exercises. The objective of the study was to evaluate efficacy of rebamipide in alleviating burning sensation of the oral mucosa in OSF in comparison with SOC intralesional steroid injections. MATERIALS AND METHODS: Twenty OSF patients were divided into two groups [rebamipide (100 mg TID for 21 days) and betamethasone (4 mg/mL biweekly for 4 weeks)] of 10 each by random sampling. Burning sensation was assessed every week for 1 month. Burning sensation scores were analyzed using repeated measures analysis of variance (ANOVA) and paired t-test. RESULTS: Change in burning sensation score was significant (p < 0.05) in the first four visits. However, score between the 4th and 5th visit was not statistically significant (p > 0.05). CONCLUSION: Our study has shown that rebamipide can be considered as an effective modality to manage burning sensation in patients suffering from OSF. CLINICAL SIGNIFICANCE: Considering stomatopyrosis and trismus as a major cause for inability to eat in OSF, use of newer adjunctive modalities, such as rebamipide will ease patients suffering and also encourage them to consume food.

Nurses' Knowledge and Education about Oral Care of Cancer Patients Undergoing Chemotherapy and Radiation Therapy.

CONTEXT: Oral health awareness and oral care are crucial aspects of oncology nursing practice. However very few studies concentrate on the oral care of cancer patients undergoing cancer treatment and nursing practice in the Indian subcontinent. Most of the published studies have been conducted in the Western and European countries. AIM: This study aimed to determine the nurses' knowledge and education about oral care in cancer patient undergoing chemotherapy and radiation therapy. SETTING AND DESIGN: A cross sectional descriptive survey was conducted among 158 staff nurses working in oncology related areas from 4 different hospitals of Dakshina Kannada district and Udupi district of Karnataka state, India. STATISTICAL ANALYSIS: descriptive and inferential statistics was used by using SPSS 16 version. RESULTS: Majority 81 (51.3%) of the staff nurses had poor knowledge of oral care in cancer patients whereas 87 (55.1%) reported that knowledge acquired through basic education in oral care is not sufficient. Most of the staff nurses 115 (72.8%) did not receive basic education in oral care of cancer patients. There was significant association between knowledge and variables such as designation (.005), years of work experience (.040) and years of experience in cancer wards (.000) at 0.05 levels. CONCLUSION: Lack of knowledge suggest the need to develop and implement continuing nursing education programs on oral care specifically for patients receiving cancer treatments, for improving knowledge of staff nurses' in order to render comprehensive care to the patients. This study also recommends the importance of inclusion of cancer patient specific oral care in the curriculum which can enhance competency of the qualified nurses in cancer wards.

Solitary neurofibroma of the gingiva.

Neurofibroma is a benign peripheral nerve sheath tumor, usually found in association with Von Recklinghausen's disease of the skin. The solitary variant commonly occurs in the head and neck region, mostly affecting young adults. They are characteristically slow-growing masses, often asymptomatic and have been found most commonly in the tongue and buccal mucosa. A recent literature review highlighting incidences in various other locations has been tabulated here. We also report a case of a solitary neurofibroma of the gingiva in a 72-year-old male of 15 years duration. Histopathology revealed a fibromyxoid stroma with sinuous nerve bundles with buckled nuclei.

Salivary protein markers: a noninvasive protein profile-based method for the early diagnosis of oral premalignancy and malignancy.

An ultra-sensitive hyphenated technique, high-performance liquid chromatography-laser-induced fluorescence detection protein profiling of saliva, is evaluated for early detection and diagnosis of oral premalignancy and malignancy. Calibration sets of protein profiles of unstimulated whole saliva are collected from clinically/pathologically normal, premalignant, and malignant subjects and used as standards. Three parameters-scores of factors, sum of squared residuals, and Mahalanobis distance-derived from principal component analysis of protein profiles of the standard calibration sets, and blind samples are used for "match/no-match" diagnosis of the blind samples. Analyses of the results show that the method is capable of differentiating normal, premalignant, and malignant conditions with the sensitivity and specificity of 79% and 78%, respectively. The technique provides a fast, highly objective (free from personal judgment and statistically defined), and noninvasive diagnostic method for screening and early detection of oral cancer.

AIDS related Kaposi's sarcoma presenting with palatal and eyelid nodule.

UNLABELLED: Kaposi sarcoma is a low-grade vascular neoplasm associated with Human Herpesvirus-8 (HHV8) infection. Although India has a large HIV infected population, Kaposi's sarcoma is rare and only 12 cases of AIDS related Kaposi's sarcoma from India have been reported in the published literature to our knowledge. The 50% of total cases in India has been reported from Mumbai. The incidence of AIDS related Kaposi's sarcoma is increasing as more than 50% of the cases are reported in 2008 to 2010. SUMMARY: We report a case of 26-year-old, HIV seropositive, Indian male with multiple, non-blanching, purplish blue nodular swellings in the palate and right upper eye lid. Similar lesions were also present on the face and the extremities. On the basis of clinical and histopathological examination, a diagnosis of AIDS related Kaposi's sarcoma was made.

Dental consultation in patients planned for/undergoing/post radiation therapy for head and neck cancers: a questionnaire-based survey.

BACKGROUND: Mouth and pharyngeal cancers account for approximately 6% of cancers worldwide. Radiotherapy is one of the means of treatment of head and neck cancer. Consultation with a dental team experienced in caring for patients undergoing treatment for head and neck cancer will improve the quality of life of such patients. AIMS AND OBJECTIVES: To evaluate the attitude of oncologists toward dental consultation to patients planning for/prior to/undergoing/post radiation therapy for head and neck cancers and to evaluate the number of radiation oncologists who encounter oral complaints and consider worth referring to a dentist. MATERIALS AND METHODS: A questionnaire-based study was carried out following mailing of covering letter and self-administered questionnaire comprising 11 items, to 25 radiation oncology centers selected in India based on convenient sampling. RESULTS: Out of the 25 centers, we received response from 20 centers with 60 completely filled questionnaires. Five centers did not respond for further correspondences. CONCLUSION: The study indicated a need for awareness and education among radiation oncologists regarding dental consultation in patients planned/undergoing /post radiation therapy for head and neck cancer.

Evaluation of high-performance liquid chromatography laser-induced fluorescence for serum protein profiling for early diagnosis of oral cancer.

The present work deals with the evaluation of a high-performance liquid chromatography laser-induced fluorescence (HPLC-LIF) technique developed in our laboratory for early detection of oral cancer from protein profiles of body fluids. The results show that protein profiles of serum samples from a given class of samples, say, normal, premalignant, or malignant, are statistically very close to each other, while profiles of members of any class are significantly different from other classes. The performance of the technique is evaluated by the use of sensitivity and specificity pairs, receiver operating characteristic (ROC) analysis, and Youden's Index. The technique uses protein profile differences in serum samples, registered by the HPLC-LIF technique. The study is carried out using serum samples from volunteers diagnosed as normal or premalignant clinically, and as malignant by histopathology. The specificities and sensitivities of the HPLC-LIF method at an ideal threshold (M-distance = 2) for normal, malignant, and premalignant classes are 100, 69.5, and 61.5%, and 86.5, 87.5, and 87.5% respectively.

Granular cell tumor of the tongue in a 6-year-old girl--a case report.

Granular cell tumor is a relatively uncommon benign hamartomatous lesion occurring in almost any part of the body. The tongue and the buccal mucosa are common intra oral sites. Granular cell lesions may be found in other diverse sites such as the jaw, skin, gastro intestinal tract and respiratory tract. The histogenesis of the lesion still remains unknown. However, histochemical and ultra structural studies propose the origin of the lesion from schwann cells, striated muscle, mesenchymal cells, histiocytes and epithelial cells. The tumor generally occurs in middle or older aged adults. The lesion is typically seen as an uninflammed asymptomatic mass measuring about two cms in diameter with a yellowish surface coloration. As most of the granular cell tumors are benign, surgical excision of the lesion is the treatment of choice. We describe a case of granular cell tumor of the tongue in a 6 year old girl along with a brief review of literature on granular cell tumors.

Recurrent desmoplastic ameloblastoma of the maxilla: a case report.

A case of desmoplastic ameloblastoma recurring within 2 months of curettage is presented. This tumour appeared in the premolar region of the left maxilla with involvement of the antrum. The 24-year-old female patient was initially treated by curettage with wide surgical margins. Later, partial maxillectomy was carried out followed immediately by iliac bone graft. The case was followed with periodic plain radiography and computed tomography. The presence of a pulpally infected premolar and the atypical radiographic appearance obscured the disease. The biologic profile of this tumour is not fully understood because of the limited number of reported cases, coupled with inadequate long-term follow-up. A review of the lesion with emphasis on the pathogenesis of recurrence is discussed.

Osteochondroma of the mandibular condyle.

Osteochondroma is one of the most common benign tumors of the axial skeleton, but is rarely found in the facial bones. When present, the tumor is most often reported to affect the mandibular coronoid process. Osteochondroma of the mandibular condyle is extremely rare. A case is presented of a massive osteochondroma of the mandibular condyle leading to facial asymmetry and disturbed occlusion. The diagnosis was confirmed by radiological and histological examination.