Presence of heavy metals in over the counter teeth whitening products- An evaluative study.

Background: Dentistry plays a crucial role in shaping the facial aesthetics of a person and thus boosts self-esteem. Tooth discolouration is one of the significant cosmetic problems and hence, many teeth whitening products are widely used for discolouration. However, these products may have heavy metals or chemicals that can affect the tooth and other organs. Aim: The aim is to estimate the amount of heavy metals present in teeth whitening products available for purchase over-the-counter in the pharmacies. Materials and Method: A cross-sectional study of teeth whitening products available Over the Counter (OTC) in pharmacies in Chennai and adjoining districts of Tamil Nadu was conducted during the period from December 2019 to February 2020. The Flame Atomic Absorption Spectrometry (FAAS) method was used to measure the heavy metals such as inorganic lead, chromium, cobalt, arsenic, cadmium, nickel and mercury in the products. Results: We collected 39 products and finalized nine for analysis. These products were available as tablet (n = 1), liquids (n = 2) and powders (n = 6). All products were mentioned as herbal or natural. Three products contained inorganic lead levels in parts per million (ppm) of 759 (product 2); 39.4 (product 3) and 28.1 (product 7), way above the permitted levels. None of the other heavy metals were detected from these products. Conclusion: After analysis with the FAAS method, inorganic lead over and above the permissible levels was observed. Dental professionals and community need to be aware of the availability of such products and its detrimental effects on oral and general health.

Preoperative neutrophil-lymphocyte ratio/platelet-lymphocyte ratio: A potential and economical marker for renal cell carcinoma.

Background: Emerging evidences have elucidated the crucial role of inflammation in carcinogenesis and tumor progression. In the recent years, many inflammatory biomarkers showed promising prognostic factors in renal cell carcinoma (RCC). We intended to evaluate the significance of one such inflammatory factor which is potential, noninvasive, simple, as well as economical. The preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in RCC patients have shown favorable results. Objective: The objective was to assess the prognostic role of NLR/PLR in the advanced stage and high-grade RCC. Subjects and Methods: This is a retrospective study. Ethical clearance was obtained from the institute ethics committee. One hundred and fifty histopathologically proven RCC cases during the period of January 2010-September 2018 were chosen from the pathology department and corresponding blood reports were obtained from the medical records department. We divided the cases based on their staging and grading. NLR/PLR values were calculated using formulas. Statistical Analysis: Statistical analysis was done using R software. Data were expressed as mean ± standard deviation, median, and percentage. Independent t-test, Mann-Whitney test, and Chi-square test were used. P < 0.05 was considered statistically significant. The receiver operating characteristic curve (ROC) was plotted to assess the sensitivity of NLR/PLR. Results: The elevated NLR/PLR values showed a significant relation with high-grade and advanced stage RCC. The ROC curve proved the accuracy of NLR/PLR in the advanced stage and high-grade RCC. Limitations: A multicentric, prospective study can be planned in the future. Follow-up studies are needed to assess their prognostic role. Conclusion: NLR/PLR values can become part of routine investigations for all RCC patients. The values may help to estimate pathological outcomes, chance of recovery, recurrence, and survival rates.

Programmed Death Ligand 1; An Immunotarget for Renal Cell Carcinoma.

BACKGROUND: In this era of developing targeted therapies and immunotherapies as a treatment for renal cell carcinoma (RCC), Programmed death ligand 1 (PDL1) as a novel biomarker for RCC is analysed in our study. About 90% of all renal cancers are Renal Cell Carcinoma. Most cases are diagnosed incidentally. 17% of cases are advanced at the time of diagnosis. PDL1 being a trans-membrane cell surface protein is expressed on the tumor cells and is found to have a chief role to inhibit the T cell immune response. It is essential to improve the host immunity by targeting the PD1/PDL1 pathway, thereby destroying the tumor progression. AIM: The aim of this study was to evaluate the expression of PDL1 in tumor cells and adjacent normal tissue among the renal cell carcinoma patients and assess the relation between the PDL1 expression and the tumor characters. METHODS: This is a retrospective study. Ethical clearance was obtained from the institution. 150 histopathologically proven RCC cases were chosen. Immunohistochemistry using a PD-L1 rabbit monoclonal antibody was performed on paraffin embedded formalin fixed tissue blocks. Q scoring was done to calculate the expression of PDL1. STATISTICAL ANALYSIS: Chi square test was done to assess the comparison between the PDL1 expression in tumor cells and their characteristic features like histology, grade and stage. SPSS (version 20.0) was used for analysis. P value <0.05 was considered significant. It also explains the heterogenous nature of PDL1 as it expressed more in the aggressive pathologic characters like high grade. RESULTS: Positive PD-L1 expression was seen in 44% of tumors. Significant association was observed between high WWHO ISUP grading and positive PDL1 expression (p=0.028). It was expressed in 75% of the sarcomatous type of RCC and 46.8% of clear cell RCCs. CONCLUSION: Our study suggests that blocking PD1/PDL1 pathway may become an effective mode of treatment in cancer immunotherapy especially for Renal Cell Carcinomas. Our findings confirmed the significant association between expression of PDL1 and the high graded tumors which proves it to be an important prognostic factor.