CONTEXT: Oral squamous cell carcinoma (OSCC) is characterized by a high degree of local invasiveness and metastasis to cervical lymph nodes and distant sites. Degradation of extracellular matrix (ECM) requires the concerted action of several extracellular enzymes, the most prominent of which are matrix metalloproteinases (MMPs). Proteolytic degradation of ECM components by (MMP-9) facilitates carcinoma cell invasion, enhances angiogenesis and tumor progression. OBJECTIVE: To assess and correlate the immunohistochemical expression of MMP-9 with clinicopathological parameters and histological grades of OSCC. SETTINGS AND DESIGN: Thirty histopathologically diagnosed cases of OSCC including 12 cases of well-differentiated squamous cell carcinoma, 12 cases of moderately differentiated squamous cell carcinoma and 6 cases of poorly differentiated squamous cell carcinoma were included in the study group. MATERIALS AND METHODS: The samples were subjected to staining using monoclonal antibodies against MMP-9 and visualized using the polymer-HRP detection system. Expression of MMP-9 was assessed in tumor epithelium/parenchyma and connective tissue stroma separately, and the mean of both was considered as average MMP-9 expression. STATISTICAL ANALYSIS: The parametric independent samples "t" test, one-way ANOVA test and Pearson's correlation test were used for the statistical analysis. RESULTS: Immunoexpression of MMP-9 increased with advancing stage and histological grade of OSCC with statistically significant results. CONCLUSION: MMP-9 plays an important role in invasion and metastasis and can serve as an independent prognostic marker.
Evidence show that shortened telomere length (TL) and low Vitamin D levels can increase the risk of type 2 diabetes mellitus (T2DM) and its associated complications. T2DM has been considered as an age-related disease, it may be associated with TL. The study aimed to evaluate the association of TL and Vitamin D levels with complications of T2DM and the impact of Vitamin D on TL in patients with T2DM. This 1-year cross-sectional study was conducted at a tertiary care hospital on 90 patients. Height, weight, body mass index, waist-hip ratio was calculated. Fasting blood sugars, postprandial blood sugar, and glycated hemoglobin (HbA1c) were analyzed. Absolute TL was obtained from quantitative real-time polymerase chain reaction (qPCR). Vitamin D estimation was done by chemiluminescent immunoassay. Descriptive analysis of the data was done using R i386 3.6.3. The study found a positive correlation between TL and Vitamin D levels (r = 0.64; P < 0.0001). The interaction with high HbA1c levels and lower levels of Vitamin D led to the shortening of TL (P = 0.0001). The median of TL and mean of Vitamin D levels were significantly less in the diabetic group (P < 0.0001). Vitamin D levels positively affected the TL and its levels had an inverse relation with the HbA1c levels. This association had a significant effect on the shortening of TL. Vitamin D also had a significant association with other diabetic complications that instigated the shortening of TL. Therefore, assessing the role of Vitamin D levels on the shortening of TL can prove to be crucial biomarkers in managing optimal glycemic levels in T2DM patients.
The odontogenic keratocyst is an enigmatic developmental cyst that deserves special attention. It has characteristic histopathological and clinical features; but, what makes this cyst special is its aggressive behavior and high recurrence rate. Odontogenic keratocyst is a benign odontogenic cyst, commonly affecting the mandible. These lesions have posed a great difficulty for the surgeons and pathologists. Few cases affecting the maxilla are also reported. Literature search suggests that odontogenic keratocysts may affect maxillary posterior and canine region. The present case reports a lesion of odontogenic keratocyst occuring in the maxillary incisor region, crossing midline which was initially misdiagnosed as infected residual cyst. After careful evaluation, it was reported as an odontogenic keratocyst. Key Words: Odontogenic keratocyst, Maxilla, Incisor teeth.
Odontogenic Cysts , Odontogenic Tumors , Humans , Mandible , Maxilla/diagnostic imaging , Maxilla/surgery , Neoplasm Recurrence, Local , Odontogenic Cysts/diagnostic imaging , Odontogenic Cysts/surgery
CONTEXT: Oral squamous cell carcinoma (OSCC) of the head and neck are a heterogeneous group of neoplasms with an increasing rate of mortality and morbidity. OSCCs are characterized by a high degree of local invasiveness and metastasis to cervical lymph nodes but show a lower rate of distant metastasis. Galectin-1 (Gal-1), a ß-galactoside-binding lectin, is known to regulate tumor cell growth, angiogenesis, mediate cell-cell or cell-extracellular matrix adhesion and promote cancer cell migration. AIMS: This study aims to evaluate the Gal-1 expression in different clinical stages and histological grades of OSCC. SETTINGS AND DESIGN: Forty histopathologically diagnosed cases of OSCC, including 16 cases of well-differentiated, 18 moderately differentiated and 6 poorly differentiated carcinomas, were included in the study group. MATERIALS AND METHODS: The samples were subjected to staining using primary mouse monoclonal antibodies against Gal-1 and visualized using polymer-HRP detection system. STATISTICAL ANALYSIS: The nonparametric Mann-Whitney U-test and Kruskal-Wallis ANOVA test were used for the statistical analysis. RESULTS: Gal-1 expression was higher in advanced stages of OSCC, and the results were statistically significant. Immunoexpression of Gal-1 increased with advancing histological grades of OSCC with statistically significant results. CONCLUSION: Gal-1 plays an important role in invasion, metastasis and as a prognostic marker.
AIM: The aim of this paper is to present an interesting case of viral myocarditis complicated by sepsis, its sequelae, including multi-organ dysfunction syndrome, and the approach to manage it successfully. BACKGROUND: Viral myocarditis is an inflammatory disease of myocardium, often leading to residual heart disease. Commonly, dengue and Coxsackie B viruses are the causative agents. Patients usually present with dyspnea, fever, and signs of heart failure. A possibility of bacterial sepsis should not be overlooked, given similar presentations may occur. CASE DESCRIPTION: A 21-year-old male presented with acute onset breathlessness, fever, chills, and severe neck pain. On a detailed workup, he was found to have features suggestive of viral myocarditis, bacterial sepsis, with bilateral pleural loculations, a posterior epidural spinal abscess. Elimination of infectious foci, along with a decision to stick to the ongoing antibiotics, instead of stepping up to the last available ones proved beneficial. Meticulous balance of diuretics and inotropes saved the patient's life from what turned out to be coxsackie myocarditis. CONCLUSION: Here, we present the case of a young male who came in with congestive heart failure due to Coxsackie myocarditis and his condition complicated by severe sepsis. CLINICAL SIGNIFICANCE: Up to 10% of the cases of coxsackie myocarditis progress to chronic dilated cardiomyopathy. The management is usually conservative, and antiviral agents have shown no role in speedy recovery. Elimination of infectious foci aggressively is of prime importance in the treatment of bacterial sepsis. A careful balance of inotropes, diuretics, and fluid management is needed to get the patient into remission in such cases. HOW TO CITE THIS ARTICLE: Morkar DN, Agarwal R, Patil RS. Coxsackie Myocarditis with Severe Methicillin-resistant Staphylococcus aureus Sepsis, Multi-organ Dysfunction Syndrome, and Posterior Epidural Spinal Abscess: A Case Report. Indian J Crit Care Med 2020;24(1):73-76.
BACKGROUND: Oral squamous cell carcinoma (OSCC) is the most common type of head-and-neck cancer. It is a complex and relentless malignancy prone to local invasion and dissemination. An insight into the molecular alterations associated with metastasis will provide critical insights into the fundamental mechanisms underlying its progression and further contribute to improvements in the clinical management of H and N cancer patients. Hence, identifying specific biomarkers would pave the way for early detection and prognosis of OSCC. Extracellular matrix metalloproteinase inducer (EMMPRIN) is a membrane-bound glycoprotein found on the surface of tumor cells. It plays a central role in the promotion of tumor invasion, progression and metastasis as it upregulates matrix metalloproteinases secreted from adjacent fibroblasts. There is a paucity of studies on the expression of EMMPRIN in OSCC. OBJECTIVES: The aim is to assess the immunohistochemical expression of EMMPRIN in OSCC and to compare it with the clinicopathological parameters and histological grades of OSCC. MATERIALS AND METHODS: Thirty histopathologically diagnosed cases of OSCC were included in the study. The slides were immunohistochemically analyzed for EMMPRIN expression and correlated with the clinicopathological parameters and histological grades of OSCC. RESULTS: EMMPRIN expression was noted in all 30 cases of OSCC. Strong EMMPRIN expression was noted in the advanced clinical stages of OSCC. Higher histological grades of OSCC exhibited strong EMMPRIN expression. CONCLUSION: EMMPRIN overexpression indicates that this protein could be used as an important biological prognostic marker to identify high-risk OSCC patients.
BACKGROUND: Coronary artery disease (CAD) accounts for 60% of all deaths and 47% of burden of diseases which is progressively increasing in rural population in terms of absolute numbers. Biological risk factors contribute significantly to the cardiovascular burden. Hence, this study was undertaken to assess the biological risk factors among adults residing in rural area. MATERIALS AND METHODS: A community-based cross-sectional study conducted among 980 adults aged between 20 and 60 years residing in rural area of Belagavi district, India. World Health Organization-STEPS-based predesigned questionnaire was used for data collection by house-to-house visit after obtaining written informed consent. Sociodemographic variables and biological risk factors which included hypertension, self-reported diabetes mellitus, overweight, and obesity were assessed. Statistical analysis was done using Pearson's Chi-square test and P value less than 0.05 was considered significant. RESULTS: In the present study, 48.8% were men and 51.2% were women. Prevalence of hypertension was 26.6%, self-reported diabetes mellitus 6.3%, overweight 26.7%, and obesity was 7.0%. Men had higher prevalence of hypertension and overweight, whereas women had higher prevalence of diabetes and obesity. A significant gender difference was noted with the biological risk factors for CAD (P < 0.05). Advancing age, lesser education, and retirement from the job were the contributors for the increasing prevalence of these risk factors (P < 0.05); however, the socioeconomic status did not show any influence (P > 0.05). CONCLUSION: Biological risk factors, which included hypertension, diabetes, and overweight, were observed in a significantly higher proportion among men, whereas women were more obese with a significant higher proportion. Advancing age, lesser education, and retirement from the job were the contributors for the increasing prevalence of these risk factors.
INTRODUCTION: Acute organophosphate (OP) poisoning is one of the most common poisoning causing significant morbidity and mortality in developing countries. Acute cholinergic manifestations predominate with many patients requiring intensive care management and ventilator support. Nerve conduction studies including repetitive nerve stimulation can evaluate the altered neuromuscular transmission and peripheral nerve function by OPs. OBJECTIVE: To evaluate the electrophysiological abnormalities in patients with acute OP poisoning and correlate with clinical status. MATERIALS AND METHODS: Patients with acute OP poisoning admitted from August 2016 to August 2017 were prospectively studied. Nerve conduction studies including phrenic nerve conduction were performed within 24 h of admission. Repetitive nerve stimulation was performed at 3 and 30 Hz. Nerve conduction findings were compared with data from age-matched healthy controls. RESULTS: Thirty patients were included (18 men and 12 women) in the study. Their age ranged from 16 to 47 years (30 ± 9.2). The first assessment revealed a mild reduction of compound muscle action potential (CMAP) amplitude and reduced F-wave persistence. Eleven patients had repetitive CMAPs suggesting cholinergic excess. Seven among the 11 patients requiring mechanical ventilation had decrement-increment response with 30 Hz stimulation and reduced diaphragmatic CMAP amplitude (P = 0.02). CONCLUSION: The presence of repetitive CMAPs, decrement-increment response to tetanic stimulation and reduced diaphragmatic CMAP amplitude in OP poisoning patients correlate with neuromuscular paralysis and need for mechanical ventilation.
Mapping the environment of a vehicle and localizing a vehicle within that unknown environment are complex issues. Although many approaches based on various types of sensory inputs and computational concepts have been successfully utilized for ground robot localization, there is difficulty in localizing an unmanned aerial vehicle (UAV) due to variation in altitude and motion dynamics. This paper proposes a robust and efficient indoor mapping and localization solution for a UAV integrated with low-cost Light Detection and Ranging (LiDAR) and Inertial Measurement Unit (IMU) sensors. Considering the advantage of the typical geometric structure of indoor environments, the planar position of UAVs can be efficiently calculated from a point-to-point scan matching algorithm using measurements from a horizontally scanning primary LiDAR. The altitude of the UAV with respect to the floor can be estimated accurately using a vertically scanning secondary LiDAR scanner, which is mounted orthogonally to the primary LiDAR. Furthermore, a Kalman filter is used to derive the 3D position by fusing primary and secondary LiDAR data. Additionally, this work presents a novel method for its application in the real-time classification of a pipeline in an indoor map by integrating the proposed navigation approach. Classification of the pipeline is based on the pipe radius estimation considering the region of interest (ROI) and the typical angle. The ROI is selected by finding the nearest neighbors of the selected seed point in the pipeline point cloud, and the typical angle is estimated with the directional histogram. Experimental results are provided to determine the feasibility of the proposed navigation system and its integration with real-time application in industrial plant engineering.
AIM AND OBJECTIVE: To study the cardiac manifestations of the dengue fever. METHODS: This one year descriptive study was undertaken at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum under the Department of Medicine. A total of 120 patients with either dengue IgM or IgM and IgG were studied. The assessment of cardiac manifestations was done based on electrocardiogram, 2D echocardiography and cardiac enzymes. RESULTS: Of the 120 patients, 85 (70.83%) were males and the male to female ratio was 2.4:1. The mean age of the patients was 33.02 ± 12.71 years. The commonest clinical presentation was myalgia (97.5%) followed by fever (92.5%). On clinical examination 33.33% of the patients had petecheia and only 9 patients having active bleeding manifestation at the time of presentation. A raised CK-MB and Troponin I was observed in 33.3% and 26.7% patients ECG findings revealed normal rhythm among 95% with 15.8% of them having an abnormal heart rate. Rhythm disturbance was noted in 5% of the patients with AV block being the most common (66.67%). Cardiac manifestation in the form of myocarditis was observed in 37.50% of the patients with a positive correlation with the severity of the dengue fever defined as by W.H.O. criteria. CONCLUSIONS: Patients with dengue fever are at high risk of developing myocarditis and rhythm disturbance and therefore require a close cardiac monitoring.
Dengue/complications , Heart Diseases/etiology , Adult , Female , Humans , Male
BACKGROUND: The luting cements must withstand masticatory and parafunctional stresses in the warm and wet oral environment. Mouth temperature and the temperature of the ingested foods may induce thermal variation and plastic deformation within the cements and might affect the strength properties. The objectives of this study were to evaluate the effect of temperature on the compressive and diametral tensile strengths of two polycarboxylate, a conventional glass ionomer and a resin modified glass ionomer luting cements and, to compare the compressive strength and the diametral tensile strength of the selected luting cements at varying temperatures. MATERIALS AND METHODS: In this study, standardized specimens were prepared. The temperature of the specimens was regulated prior to testing them using a universal testing machine at a crosshead speed of 1 mm/min. Six specimens each were tested at 23°C, 37°C and 50°C for both the compressive and diametral tensile strengths, for all the luting cements. RESULTS: All the luting cements showed a marginal reduction in their compressive and diametral tensile strengths at raised temperatures. Fuji Plus was strongest in compression, followed by Fuji I > Poly F > Liv Carbo. Fuji Plus had the highest diametral tensile strength values, followed by Poly F = Fuji I = Liv Carbo, at all temperatures. CONCLUSION: An increase in the temperature caused no significant reduction in the compressive and diametral tensile strengths of the cements evaluated. The compressive strength of the luting cements differed significantly from one another at all temperatures. The diametral tensile strength of resin modified glass ionomers differed considerably from the other cements, whereas there was no significant difference between the other cements, at all the temperatures.
AIM: To Quantify the DNA single-stranded breaks in the peripheral blood leukocytes (PBLs) of tobacco-habituated individuals with clinically normal mucosa and patients with oral carcinoma. OBJECTIVES: To evaluate DNA damage levels in PBLs of tobacco-habituated individuals with clinically normal mucosa and patients with oral carcinoma and compare with a control group of healthy volunteers. To evaluate the extent of DNA damage in PBLs using Single Cell Gel Electrophoresis (SCGE) in the above groups. MATERIALS AND METHODS: Patients who were attending the outpatient department were enrolled in this study. A control group of 30 healthy volunteers included in Group I were selected from various age groups who are not tobacco users in any form. Thirty patients with tobacco habituation but with clinically normal mucosa were included in Group II, while 30 tobacco-habituated patients with oral squamous carcinoma were included in Group III. A biopsy was taken from the representative area and confirmed histologically. Intravenous blood samples were collected from all the groups for evaluation of the extent of DNA damage using ethidium bromide-stained slides under fluorescent microscope. The DNA tail length was calculated by subtracting the diameter from the total length. Twenty-five randomly selected cells per slide were analyzed and mean calculated. RESULTS: The mean DNA damage levels in patients with tobacco habits were compared with that of the control group and the results were found to be statistically significant. The mean DNA damage level in PBLs between tobacco-habituated patients with normal mucosa and oral cancer patients was found to be statistically significant. The DNA damage in cancer patients was compared with the control group and the results were found to be statistically significant. CONCLUSION: DNA damage evaluation in PBLs by SCGE technique is a sensitive and reliable indicator of tobacco insult.
Verruciform xanthoma is a very uncommon papillary growth seen chiefly in the oral mucosa. The presence of foam cells in the connective tissue papillae between the epithelial rete ridges forms the hallmark in its diagnosis. There has been wide speculation and various hypotheses put forth in explaining the etiopathogenesis of verruciform xanthoma and the origin of foam cells. This article aims to update the different hypotheses in understanding the pathogenesis of the lesion.
AIM: Altered lipid profile patterns have been associated with malignancies because lipids play a pivotal role in the maintenance of cell integrity. The present study evaluated alterations in serum lipid profile in oral squamous cell carcinoma patients as well as its association with the habit of tobacco consumption. MATERIALS AND METHODS: The study included 30 oral squamous cell carcinoma patients, 20 patients with the habit of tobacco consumption and 20 controls. Serum lipids, including (i) total cholesterol, (ii) LDL cholesterol (LDLC), (iii) HDL cholesterol (HDLC), (iv) VLDL cholesterol (VLDLC) and (v) triglycerides, were analyzed by spectrophotometric kits. RESULTS: A significant decrease in serum total cholesterol (TC) levels, triglyceride levels (p = 0.007, p = 0.029 respectively) were observed in oral squamous cell carcinoma patients as compared to the healthy control group. The mean serum HDLC levels (p = 0.003) were significantly lowered in the tobacco habituates when compared to the healthy controls. The mean serum total cholesterol levels were significantly lower in subjects with oral squamous cell carcinoma (p = 0.000) as compared to the tobacco habituates. Likewise, LDLC levels and TC:HDLC ratios (p = 0.000 and p = 0.000 respectively) were significantly decreased in oral squamous cell carcinoma patients as compared to the tobacco habituates. Our data strengthens the evidence of an inverse relationship between serum lipid levels and oral squamous cell carcinoma. CONCLUSION: The lower level of serum cholesterol and other lipid constituents in the patients is thought to be due to their increased usage by tumor cells for new membrane biogenesis. CLINICAL SIGNIFICANCE: The lower serum lipid profile status serves as a useful indicator for gauging initial changes occurring in tumor cells. A detailed study of the cholesterol carrying lipoprotein transport mechanisms helps in better understanding of the underlying mechanisms of the regulation of serum cholesterol concentrations in cancer.
Carcinoma, Squamous Cell/blood , Lipids/blood , Mouth Neoplasms/blood , Cholesterol/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Cholesterol, VLDL/blood , Humans , Smoking/blood , Spectrophotometry , Triglycerides/blood
Hairy tongue (HT) is a benign condition that causes concern over its abnormal appearance. HT is most commonly seen in adults and is seen as an abnormal coating of the tongue due to hyperkeratosis of filiform lingual papillae. Cytological scraping of the lesion on the tongue was done which showed squamous cells, extraneous material, bacterial colonies, fungal bodies, and hair-like projections, which are the hall mark of the disease. We present a case along with its scrape cytology findings.
