Association of Insulin Receptor Substrate 1 Expression in the Prognosis of Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.

INTRODUCTION: Head and neck squamous cell carcinoma (HNSCC) is the most common mucosal neoplasm that affects the head and neck region. It is the 6th most common cancer globally, most commonly seen in South Asian countries. Insulin receptor substrate 1 (IRS-1), like insulin receptor, is an adapter protein that integrates multiple transmembrane signals from growth factors and hormones, to regulate cell growth, survival, differentiation, and metabolism. Evidence suggests that IRS-1 plays a vital role in cancer progression and nodal metastasis. The aim was to assess the prognostic implications of the IRS-1 expression in HNSCC from evidence-based results. METHODS: A systematic literature search was done to identify articles describing IRS-1 and HNSCC carried out for PubMed, Cochrane, and Google Scholar, using MeSH terms. RESULTS: A total of 486 cases of HNSCC were included in this systematic review. Out of 3 studies, increased/high expression of IRS-1 was 67%. 64% of the cases in stage I and stage II (TNM staging) showed higher expression of IRS-1, whereas 70% of stage III and stage IV cases showed upregulation of IRS-1. IRS-1 was equally upregulated in cases with lymph node metastasis as well as in cases without any lymph node metastasis. 74% of the patients who showed high expression of IRS-1 showed high mortality during the follow-up period of 13 months. CONCLUSION: This review concluded that elevated levels of IRS-1 expression were associated with poor prognosis and increased lymph node metastasis.

Targeting Oral Cancer: In Silico Docking Studies of Phytochemicals on Oncogenic Molecular Markers.

OBJECTIVE: Molecular docking is a key tool in structural molecular biology and computer-assisted drug design. Oral carcinogenesis is a complex, multistep process in which genetic events within signal transduction pathways governing normal cellular physiology are quantitatively or qualitatively altered. There are various molecular targets like Cyclin D and PI3k- alpha Ras Binding Domain receptor protein involved in the pathogenesis of Oral Squamous Cell Carcinoma. The aim of the study is to demonstrate the computer aided drug design to identify a potent natural molecule for targeting cyclin D4 and PI3K RAS binding protein. MATERIALS AND METHODS: Target selection (Cyclin D1 and PI3K-alpha Ras Binding Domain receptor) was done and structures were derived from protein data bank. Ligands (Apigenin, Chrysoeriol and Luteolin) selection was done and structure derived. Final docking was performed by Autodock. RESULTS: From the docking results it can be seen that luteolin has the highest binding energy (-5.45) with the Cyclin D receptor molecule followed by Chrysoeriol (-4.99) and Apigenin (-4.96). The binding energies of the ligands against PI3K-alpha Ras Binding Domain receptors were Apigenin (-4.51), Chrysoeriol (-4.6) and Luteolin (-4.56). CONCLUSION: The study concludes that all the three selected ligands possess high binding energy with both the target proteins involved in carcinogenesis with highest binding energy possessed by Luteolin against the Cyclin D receptor and by Chrysoeriol against PI3K-RAS binding protein. Thus their activity can be utilized to derive potential Anti-cancer therapeutic drugs.

Modifications of Gallego staining and its dental application.

BACKGROUND: The objectives of the study are to employ modified Gallego staining in pathology and to specifically evaluate the hard tissue apposed to odontogenic epithelium in order to aid in the diagnosis. METHODS: Lillie's modification of Gallego's stain was utilized as a reference to create a fresh batch of the stain. The archival and running cases of 2021-2022 was screened for odontogenic pathologies, yielding approximately 46 cases, among these four cases were selected which required evaluation of the hard tissue matrix apposed to odontogenic epithelium for its characterization. The modified Gallego staining was employed in the soft tissue sections of these cases under controlled environment. The staining results were evaluated. RESULTS: The stain was used in cases to stain dentinoid deposition as green color in hybrid ameloblastoma, archegonous cystic odontoma, dentinogenic ghost cell tumor and also in other cases like calcifying odontogenic cyst. Bone presented as green in color, cells as pink color and collagen as green-pink. This helped in the correct diagnosis of these cases facilitating the correct treatment modality. CONCLUSIONS: In the field of oral pathology, there are a multitude of lesions which are odontogenic with the diagnosis of few of them hinging on the characterization of hard tissue matrix found in close approximation to odontogenic epithelium implying an inductive capability to the odontogenic epithelium. This particular modified Gallego stain has been able to help in diagnosis of few such cases in our repertoire of cases.

A massive dentinogenic ghost cell tumor that crossed the midline: A rare case report.

Dentinogenic ghost cell tumor (DGCT) is a rare tumor of odontogenic origin. A locally invasive lesion can be described by the presence of ameloblast-like epithelial islands, ghost cells, and dentinoid material. It is one of the few lesions with a predilection for the Asian population. The available literature has revealed that only 131 cases to date have been reported and published from 1968 to 2022. The following is a case report of a 25-year-old male with a tumor in the left lower back teeth region for the past 1 month. Orthopantomogram (OPG) reveals a well-defined unilocular radiolucency extending anteroposteriorly and crossing the midline. Histopathology revealed basal ameloblast-like cells and central stellate reticulum-like cells with the characteristic presence of ghost cells. The diagnosis was made based on the clinical, radiographical, and histopathological correlation and was confirmed using immunohistochemical analysis as a DGCT.

Oral Microflora and Its Potential Carcinogenic Effect on Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.

The oral cavity has the second largest and most diverse microflora. A wide variety of bacteria, viruses, and fungi are present in the oral cavity. A significant number of studies have shown the important role of oral microflora in the initiation and pathogenesis of oral squamous cell carcinoma (OSCC). Microorganisms like Staphylococcus, Streptococcus, Neisseria, Prevotella, Fusobacterium, Porphyromonas, Herpes Simplex Virus I (HSV-1), Epstein-Barr Virus (EBV), Human Papilloma Virus (HPV), Candida plays an important role in OSCC. Increased microbial load affects tumor initiation and progression through direct effects on the tumor cells and indirectly through manipulation of the immune system. But the mechanisms describing the steps of oral microflora initiating the OSCC remain an enigma. This systematic review aims to understand the potential carcinogenic effect of oral microflora on OSCC. A systematic literature search was done in PubMed and Google Scholar databases, and six studies were obtained, comprising 1267 participants. The incidence was evaluated as an odds ratio (OR) with a 95% confidence interval (95% CI) using review manager 5.2 software. Oral microflora increased 2.10-fold risk of oral squamous cell carcinoma (OR=2.10, 95% CI: 0.76, 5.84, P= 0.15, I2=86%, Ph<0.00001). In our subgroup analysis, there is a significant relation between Fusobacterium and oral squamous cell carcinoma (OR= 4.86, 95% CI: 0.99, 23.82, P=0.05, I2=0%, Ph= 0.84). Individuals with Epstein-Barr Virus infection exhibit increased incidence of oral squamous cell carcinoma (OR= 3.72, 95% CI: 1.97, 7.04, P=<0.0001, I2=0%, Ph= 0.82). The meta-analysis revealed that oral microflora increases the risk of oral squamous cell carcinoma.

Molecular docking analysis of syringic acid with proteins in inflammatory cascade.

Syringic Acid (SA) is a dimethoxybenzene derived from plants. Dietary SA possesses anti-obesity, anti-inflammatory and anti-steatotic effects and is of interest as a potential therapeutic medication in the treatment of obesity, diabetes, diabetic cataracts and asthma. It has anti-tumorigenic effect against hepatocellular carcinoma, lung carcinoma and oral mucosal carcinoma. It is also believed to have a protective effect on Acetaminophen induced damage in Wistar rats. Therefore, it is of interest to document the molecular docking analysis of syringic acid with proteins in inflammatory cascade such as TNF α, NFκB, P50, P65 and IKB for further consideration in drug discovery.

Apoptolysis: a less understood concept in the pathogenesis of Pemphigus Vulgaris.

Pemphigus Vulgaris (PV) is a severe autoimmune disease characterized by supra-basal blisters in the skin and mucous membranes of a wide range of mammals, including humans. It not only affects the skin but also has severe oral manifestations. It has been stated that auto-antibodies are produced, for unknown reasons, which are directed against desmogleins present on the epithelium and thus leads to acantholysis and intraepithelial blistering. But the exact mechanism is still not completely understood. Here we would like to shed light on a new pathologic mechanism i.e., apoptolysis, which emphasizes that apoptotic enzymes contribute to acantholysis development both in terms of molecular events and chronologic sequence. A possible role of apoptolysis has been discussed in purview of PV.

Anti-inflammatory and antimicrobial effects of herbal formulation using karpooravalli, mint, and cinnamon on wound pathogens.

Wound damage must be shielded from inflammatory responses caused by the external environment, while also receiving adequate moisture and promoting wound healing. Cinnamomum verum, Coleus aromaticus/amboinicus, and Mentha have proven effects on anti-inflammatory and antimicrobial effects as separate in various studies, but no studies have observed the synergistic effects of one herb on the other. The aim of the present study is to assess the anti-inflammatory and antimicrobial properties of karpooravalli, mint, and cinnamon formulation against wound pathogens for better healing of mouth ulcers through an in vitro study for further mouth paint preparation. Herbal extract is prepared using herbal plants karpooravalli, mint, and cinnamon. We studied the antimicrobial effects on Escherichia coli, Staphylococcus aureus, and Pseudomonas with ampicillin antibiotic disks as positive control and anti-inflammatory with control of diclofenac sodium. The antimicrobial activity of zone of inhibition increased with higher concentration of 100 µL against E. coli, S. aureus, and Pseudomonas at 20 mm, 18 mm, and 15 mm, respectively. The anti-inflammatory activity showed the highest percentage of inhibition using 50 µL with 91.5%; this reveals good anti-inflammatory activity by the synergistic action of the herbal formulation. The synergistic effect of the herbal formulation had a comparable anti-inflammatory activity as that of the standard. Hence, it can be employed in large-scale production and may be used for fabricating a natural product based on mouthwashes and mouth paints.

Critical appraisal of different triggering pathways for the pathobiology of pemphigus vulgaris-A review.

Pemphigus vulgaris is an autoimmune blistering disease with an increased potential for mortality. The epithelium is key in understanding the pathobiology as it is specialized to perform functions like mechanical protection, immunological defense, and proprioception. In order to perform these array of functions, epithelial integrity is important. This integrity is maintained by a host of molecules which orchestrate the ability of the keratinocytes to function as a single unit. Desmoglein 3 antibodies formed in genetically susceptible individuals are known to cause the disruption of the intact oral mucosa leading to the formation of blisters in pemphigus vulgaris patients. However, there are underlying complex triggering pathways leading to the clinical disease. The aim of the review is to congregate and critically appraise the various triggering pathways which contribute toward the pathobiology of pemphigus vulgaris. Articles relevant to the pathobiology of pemphigus vulgaris were identified from various search databases till the year 2020. The pathogenesis of pemphigus vulgaris is complex, and it involves an in-depth understanding of the various predisposing factors, provoking factors, and progression mechanisms. Congregation of the various triggering pathways will open our minds to understand pemphigus vulgaris better and in turn develop a reliable treatment in the near future.

Particle size penetration rate and effects of smoke and smokeless tobacco products - An invitro analysis.

Utilization of tobacco products is a global epidemic that causes a health threat among the adolescents and adults of the world. If the current pattern perpetuates, it is estimated to cause 10 million deaths each year by 2020. According to the 2009-2010 survey by Global Adult Tobacco Survey, 53.5% of Indians use tobacco products (66.2% of men and 40% of women). Cancers of the lip and oral cavity are highly frequent in Southern Asia (eg: India and Sri Lanka) and it is also the leading cause of cancer death among men in India and Sri Lanka. AIM AND OBJECTIVES: The aim of the study is to evaluate the particle size, and assess the penetration rate in egg shell membrane and proliferation rate using cell lines among 4 commercially available tobacco products. MATERIALS AND METHODS: A total of 4 tobacco product samples namely Gutka, Khaini, Beedi and Cigarette was used to analyse the particle size using High resolution Scanning electron microscopy, the penetration rate on egg shell membrane using Spectroflurometry and proliferative rate using ELISA on cell lines respectively. RESULTS: Khaini revealed the smallest particle size and highest penetration and proliferation rate compared to Gutka, Beedi and Cigarette. CONCLUSION: Current evidence shows that individuals who consume Khaini are at high risk to develop potentially malignant disorders and oral squamous cell carcinoma when compared to Gutka, Beedi and Cigarette (in the order of occurrence).

Workplace violence among dental surgeons - A survey.

BACKGROUND: Workplace violence is a multi-causal, multifaceted, public health, legal and social problem faced by all occupations worldwide. Recently, there has been an increase in the prevalence of workplace violence against doctors. Even though the government has attempted to address these problems in India, doctors are still experiencing violence in their workplaces. AIM: The aim of this survey was to determine the prevalence and awareness of workplace violence among dental surgeons. METHODOLOGY: This cross-sectional study was conducted among the dental surgeons. A self-administered questionnaire containing 15 questions was made and validated. A Web-based questionnaire was developed using Google forms and was circulated. A total of 112 responses were obtained. Questions were answered with "yes" "no" or by marking the correct responses. Frequency analysis and percentage analysis were done with the obtained results. RESULTS: Our study showed that 74.1% of the participants heard about the workplace violence and 30.4% faced violence in their clinic. The nature of the violence was physical in 0.9%, verbal in 39.3%, and sexual in 0.9% among the participants who faced violence. A total of 92.9% of the participants reported that they require policies and guidelines against this workplace violence. CONCLUSION: Dental surgeons should have proper knowledge about the work-related violence and methods to control this violence. Policies, procedures, and intervention strategies should be undertaken to manage this alarming issues.

Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes.

AIM: The aim of the study is to analyse the knowledge about oral lesions, the symptoms of such lesions and their attitude towards the treatment of these problems faced by institutionalised geriatric individuals. METHODS AND MATERIALS: This questionnaire-based survey was conducted among 103 institutionalised elders residing at various institutions. The questionnaire consisted of questions that addressed the medical and dental issues faced by the institutionalised elders and assessed their knowledge and attitude towards dental health. All the received responses were tabulated and the results were represented graphically. RESULTS: The results of the study showed that 44.66% of the elders underwent medical check-up once yearly and 72.82% of them visited the dentist. Of all 103 elders, none of them used dentures in spite of being edentulous and only 29.13% had any knowledge about oral lesions while the rest had no knowledge of the oral lesion and considered these lesions to be normal changes with increasing age. CONCLUSIONS: The findings of the present study demonstrate the need to improve access to oral healthcare and dental health education for the institutionalised elder population. In spite of the limitations of the study, we were able to record the obvious lack of dental hygiene practises, neglect and lack of motivation for proper dental care.

Saliva as a Diagnostic Tool in Oral Squamous Cell Carcinoma - a Systematic Review with Meta Analysis.

Whole saliva is mainly composed of fluid produced by major and minor salivary glands. Major salivary glands including parotid, submandibular, and sublingual glands, are known to secrete fluid transported from serum as well as surrounding glandular tissues [1]. Beside the secretions from salivary glands, oral mucosa, periodontium, as well as oral microflora also contribute to the final content of whole saliva [1]. Whole saliva therefore represents a complex balance among local and systemic sources [2]. This allows for the application of saliva in the diagnosis not only for salivary gland disorders but also for oral diseases and systemic conditions [2]. The role of saliva as a diagnostic tool in detecting Oral Squamous Cell Carcinoma. Articles published in PUBMED, EMBASE, COCHRANE, GOOGLE, manual search and back references of the articles for last 5 years extracted 77 articles. Studies which considered saliva as a diagnostic tool were included. Statistical analysis with Receivers Operating Curve to establish sensitivity and specificity of the salivary biomarkers as a diagnostic tool to detect Oral Squamous Cell Carcinoma were included for meta analysis. The measure of effect with 95% confidence interval were meta analysed for 9 articles in which 308 healthy individuals compared with 340 patients with Oral Squamous Cell Carcinoma. Highly sensitive salivary biomarkers for detecting Oral Squamous Cell Carcinoma were MMP-9, Chemerin, Choline + Betaine + Pipecolinic Acid + I - Carnitine(confidence interval ranges from 0.83-1.0). The narrow confidence interval of 0.95 + (0.88-1.00) was seen for MMP-9 followed by 1.00 + (0.78-1.00) for chemerin. Highly specific biomarkers for Oral Squamous Cell Carcinoma were MMP-9 (specificity -100%,), Chemerin(specificity-100%), over expressed mi RNA 136 with specificity of 0.88(0.69-0.97), under expressed mi RNA 27B with specificity of 1.0(0.66-1.00). Saliva can be used as a diagnostic tool with highly sensitive and specific markers namely MMP-9, Chemerin for early detection of Oral Squamous Cell Carcinoma.

Molar Incisor Hypomineralization and Its Prevalence.

BACKGROUND: Molar incisor hypomineralization (MIH) is the hypomineralization of systemic origin of one to four permanent first molars, frequently associated with affected incisors. It is presented as demarcated enamel opacities of different colors, occasionally undergoing posteruptive breakdown. The characteristic feature of MIH is the clear demarcation between the affected and sound enamel. There is asymmetry of defects present in the molars and incisors where one molar or incisor can be severely affected, while the contralateral tooth may be clinically sound or have only minor defects. AIM AND OBJECTIVE: The aim of this study is to evaluate schoolchildren of 7-12 years of age with at least one of the first permanent molars fully or partially erupted from randomly selected government and private schools in Chennai using the European Academy of Pediatric Dentistry (EAPD) criteria for MIH, to determine the prevalence and characteristics of MIH. MATERIALS AND METHODS: The dental examinations were performed in the classroom using a mouth mirror and explorer under a headlight. Teeth were wiped with gauze when necessary to remove plaque or the food accumulations. Surfaces that were examined were the buccal, lingual, palatal, and occlusal surfaces of permanent first molars and labial surfaces of upper and lower incisors. A single examiner was involved to avoid interexaminer bias. All the data were collected and scored using the EAPD criteria for MIH. RESULTS: A total of 22 (12.9%) children out of the examined 170 had MIH. CONCLUSION: Distribution of MIH was more in males, more in 9 years of age. A total of 13 children had first molars affected and 9 children had both incisors and molars affected. Molars were affected more than the incisors. Mandible was affected more in comparison with the maxilla. Right side was affected more than the left side. The distribution of MIH was more in government schools compared to private schools.

Surgical Specimen Handover from Operation Theater to Laboratory: A Survey.

INTRODUCTION: Essential communication between surgeons and pathologists is required when a specimen is transferred from operation theater to a laboratory. Any errors during transferring of specimen can lead to serious consequences such as wrong diagnosis, inappropriate treatment, reoperations, and physical and emotional disaster. AIM: To evaluate the incidence of mishaps and misses during the transfer of specimen from operation theater to pathology department. METHODOLOGY: This cross-sectional study was conducted among the oral and maxillofacial surgeons and postgraduate students of the Department of Oral and Maxillofacial Surgery. A self-administered questionnaire containing 15 questions pertaining to entry, collection, preservation, and transport of specimens to the laboratory was made. The questionnaire was validated and later distributed to the participants. RESULTS: Our study showed that there are misses and mishaps during the entry, collection, preservation, and transport of specimen to the laboratory. 97.1% of participants reported that they require a checklist during the transfer of specimen. CONCLUSION: Use of checklist can reduce mishaps and communication failures which is an initial link for reporting.

Immunohistochemical Expression Of Ezrin In Oral Potentially Malignant Disorders-A Descriptive Study.

INTRODUCTION: Ezrin, also known as cytovillin, is a member of the ERM family of protein. Ezrin cross-links actin filament with the plasma membrane. They are involved in the formation of microvilli, cell-cell adhesion, maintenance of cell shape, cell motility, and membrane trafficking. Recent analysis reveals their involvement in signaling pathways. Ezrin is highly expressed in several types of human cancers, and correlation between its immunoreactivity and histopathological data as well as the patient outcome has previously been studied. OBJECTIVE: The objective of the study was to analyze the immunohistochemical expression pattern of ezrin in oral potentially malignant disorders (OPMDs), namely, oral submucous fibrosis (OSMF) with different grades and clinically leucoplakia (hyperkeratosis with various degree of dysplasia) and its use as a predictive marker for malignant transformation. SUBJECTS AND METHODS: Sample size n = 43, histopathologically confirmed cases of OPMDs (13 cases of OSMF with different grades and 30 cases of clinically leukoplakia) were retrieved from the Department of Oral and Maxillofacial Pathology. Immunohistochemistry was done using anti-ezrin antibody, and the expression was graded in terms of proportion and intensity. RESULTS: There was a significant expression of ezrin in OPMDs, and its cytoplasmic shift can be used as a predictive marker for malignant transformation. CONCLUSION: The findings of the current study revealed that the expression of ezrin in OPMDs may be related to the progression of the disease.

Giant cell tumor of the mandible.

Giant cell tumor (GCT) of bone is a distinctive neoplasm characterized by abundance of multinucleated giant cells scattered throughout the stroma of mononuclear cells. Its importance lies in recognizing and differentiating the characteristic histology, which at times may mimic several other bone tumors and endocrine disorders ranging from locally aggressive giant cell granulomas to hyperparathyroidism to malignant tumors. The jaw bones account for less than 1% of the lesion. Ina literature search, we found only five cases of GCT of jaw bones based on the new criteria. We present a rare case of GCT of the mandible which occurred in a 12-year-old female.