Automated Analysis of Nuclear Parameters in Oral Exfoliative Cytology Using Machine Learning.

BACKGROUND: As oral cancer remains a major worldwide health concern, sophisticated diagnostic tools are needed to aid in early diagnosis. Non-invasive methods like exfoliative cytology, albeit with the help of artificial intelligence (AI), have drawn additional interest. AIM: The study aimed to harness the power of machine learning algorithms for the automated analysis of nuclear parameters in oral exfoliative cytology. Further, the analysis of two different AI systems, namely convoluted neural networks (CNN) and support vector machine (SVM), were compared for accuracy. METHODS: A comparative diagnostic study was performed in two groups of patients (n=60). The control group without evidence of lesions (n=30) and the other group with clinically suspicious oral malignancy (n=30) were evaluated. All patients underwent cytological smears using an exfoliative cytology brush, followed by routine Hematoxylin and Eosin staining. Image preprocessing, data splitting, machine learning, model development, feature extraction, and model evaluation were done. An independent t-test was run on each nuclear characteristic, and Pearson's correlation coefficient test was performed with Statistical Package for the Social Sciences (SPSS) software (IBM SPSS Statistics for Windows, Version 28.0. IBM Corp, Armonk, NY, USA). RESULTS:  The study found substantial variations between the study and control groups in nuclear size (p<0.05), nuclear shape (p<0.01), and chromatin distribution (p<0.001). The Pearson correlation coefficient of SVM was 0.6472, and CNN was 0.7790, showing that SVM had more accuracy. CONCLUSION: The availability of multidimensional datasets, combined with breakthroughs in high-performance computers and new deep-learning architectures, has resulted in an explosion of AI use in numerous areas of oncology research. The discerned diagnostic accuracy exhibited by the SVM and CNN models suggests prospective improvements in early detection rates, potentially improving patient outcomes and enhancing healthcare practices.

EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN ODONTOGENIC CYSTS AND TUMORS.

BACKGROUND: Odontogenic cysts and tumors exhibit different degrees of aggressiveness in their biological behavior. There has been evidence that the presence of myofibroblasts (MFs) at the invasion front promotes tumor invasion. Our study is based on the fact that MFs are important in the biological behavior of odontogenic cysts and tumors. AIM: To assess immunohistochemically expression of alpha-smooth muscle actin (α-SMA) of MFs in odontogenic cysts and tumors and correlate this expression to their biological behavior. MATERIALS AND METHODS: The archival tissues collected for 1.5 years were obtained from the Department of Oral Pathology & Microbiology, People's Dental Academy, Bhopal (India). A total of 40 cases consisting of 10 cases each of odontogenic keratocysts, radicular cysts, dentigerous cysts and ameloblastomas formed the study group. An immunohistochemical analysis of α-SMA expression and localization was carried out. RESULTS: Mean MF counts were the highest in odontogenic keratocysts which was followed by ameloblastomas, entigerous cysts and radicular cysts. Weak α-SMA-expression was found in 50% of cases, moderate in 22.5% of cases, and intense - in 10% cases. MFs were arranged in the spindle, focal, or network patterns in 35; 27.5 and 20% of cases, respectively. CONCLUSION: The analysis revealed that the MFs were distinctly heterogeneous in distribution and pattern of arrangement. This provided persuasive evidence that stroma of these lesions harbor MFs as reflected by α-SMA immunopositive cells.

Post Surgical Non-tuberculous Mycobacterium: A Case Series.

Background There has been an increase in non-tuberculous mycobacteria (NTM) infection reports in humans. Surgeons are concerned about the link between them and surgical site infections. As a result, it has been challenging to determine just how common this illness is. A two-year study by the authors examines the occurrence of NTM infections after different surgical procedures. Design and methods Researchers at a tertiary care hospital in central India performed this prospective study over two years. NTM was found in six of the 25 instances of post-surgical wound infections. Ziehl-Neelsen staining, Auramine O-Rhodamine fluorescence staining, Multiplex Real-Time PCR, and Genotyping were used to identify the species. Results M. fortuitum, M. chelonae and M.kansasii were isolated from discharge in 2 cases each respectively. NTM isolates evaluated for antibiotic susceptibility pattern were all sensitive to Clarithromycin (100%). One case with prolonged healing had to be intervened with amikacin along with clarithromycin. Conclusion NTM is an infection of uncommon nature which can occur following surgical procedures. Identification of these organisms through sensitive techniques and appropriate therapeutic regimen formulation must be done to tackle this growing menace in health care setups.

Elective Neck Dissection Versus Therapeutic Neck Dissection in Clinically Node-Negative Early Stage Oral Cancer: A Meta-analysis of Randomized Controlled Trials.

Introduction: Oral squamous cell carcinoma (OSCC) is characterized by a high risk of cervical lymph node metastasis; however, it is still not clear whether patients with early stage OSCC with clinical N0 neck should undergo elective neck dissection (END) at the time of primary tumor removal, or they should undergo a conservative approach of observation (OBS), with therapeutic neck dissection at the time of lymph nodal recurrence. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared these two approaches. Methods: PubMed and Scopus databases were searched for RCTs published in English language related to END and OBS in patients with early stage OSCC with clinical N0 neck. A meta-analysis was performed using random effects model with hazard ratio (HR) as the effect size for survival parameters and odds ratio (OR) as the effect size for lymph nodal recurrence. Results: A total of 7 RCTs, comprising 1250 patients were included in the meta-analysis. Results of the meta-analyses showed that as compared to OBS approach, END could significantly improve overall survival (HR 0.67; 95% CI 0.53, 0.86) and disease-free survival (HR 0.64; 95% CI 0.46, 0.89), and significantly reduce lymph nodal recurrence (OR 0.28; 95% CI 0.12, 0.66). After correcting for heterogeneity, the disease specific survival was also found to be improved by the END approach (HR 0.53; 95% CI 0.29, 0.98). Conclusion: The results of this meta-analysis suggest that elective neck dissection at the time of resection of the primary tumor not only leads to a reduced chance of nodal recurrence, but also confers a survival benefit in patients with clinically node-negative early stage oral cancer.

Impact of Oral Lichen Planus on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis.

Oral health-related quality of life (OR-QoL) measurement in patients with oral lichen planus (OLP) can provide valuable information for the optimal management of their clinical conditions. The main objective of the present study was to assess the OR-QoL of patients with OLP as measured by the short-form Oral Health Impact profile-14 (OHIP-14) questionnaire. PubMed/MEDLINE, ISI/Web of Science, clinical trial registry, Embase, Scopus, and grey literature (via Google Scholar and Scilit) were searched. Reviewers independently screened titles/abstracts, assessed full-text articles, extracted data, and appraised their quality. Random effect analysis along with subgroup analysis for age, gender, and clinical type was performed. Seventeen studies were included. Mean overall OH-QoL was 15.20, [95% CI 12.176, 18.231]; a higher OHIP-14 score was seen in OLP patients, resulting in poor OH-QoL. The impact of OLP on OH-QoL life was moderate as compared to healthy subjects. However, medical treatment of the disease improved the OH-QoL and thus reduced the impact of OLP on it. OH-QoL among patients with OLP is generally poor. Clinicians and physicians should consider the OH-QoL of these patients as part of patients' evaluation and modulate the administered treatment based on the OH-QoL response.

Oral health-related quality of life in oral cancer patients: systematic review and meta-analysis.

Aim: The purpose of this meta-analysis was to evaluate the impact of oral health on quality of life in oral cancer patients (OCPs). Methods: PubMed, Scopus and Web of Science databases were searched for publications on oral health-related quality of life (OHRQoL) in OCP and the information was extracted according to the PRISMA guidelines. A random effect model was used to obtain the pooled standard mean differences of Oral Health Impact Profile (OHIP)-14 questionnaire responses in meta-analysis. Results: total of 12 research papers were analyzed and revealed poor OHRQoL in OCPs (standard mean difference: 2.53; 95% CI: 1.55-3.50; p < 0.00001) compared with healthy individuals due to the effects of oncotherapy. Moreover, OHRQoL deteriorated with combinations of different treatment modalities. Conclusion: Oral health and oncotherapy can affect the quality of life in OCPs.

A systematic scoping review on utility of cytomorphometry in the detection of dysplasia in oral potentially malignant disorders.

BACKGROUND: Oral exfoliative cytology is simple, non-invasive, inexpensive tools prone to subjective bias. Objective computer-based quantitative cytomorphometry technique was developed in last few decades to overcome its limitation. However, there is no consensus about the utility of cytomorphometry as a routine screening tool for early detection of dysplastic changes. OBJECTIVES: To review the utility of cytomorphometry in OPMDs in the detection of dysplasia changes. METHOD: A scoping review was undertaken focusing on cytomorphometric analysis in exfoliative cells for detection of oral epithelial dysplasia and cytomorphometric parameter denoting dysplasia. The systematic search was carried out in the online journal databases (Scopus, Google Scholar, PubMed, Web of Science) using keywords until December 2019 for the studies evaluated the cytomorphometry in the detection of dysplastic changes in OPMDs. Three authors independently extracted data using collection forms. RESULT: The search strategy found seven analytical cross-sectional studies for scoping review after eliminating 8940 out of 8947 initial results. The scoping review showed that cytomorphometry is useful tool in detecting the dysplastic changes in OPMDs. In addition, decrease in mean cellular area, increase in mean nuclear area, and decrease in mean cell diameter, increase mean nuclear diameter, increase in mean nuclear and cytoplasmic area ratio, associated with development of dysplastic changes in OPMDs. CONCLUSION: Cytomorphometry is promising tool, yet there is currently no-good evidence to support role of cytomorphometry in detecting the dysplastic changes in OPMDs in this setting. More research is required for refinement of cytomorphometry as a screening tool.

Assessment of Tumor Cell Cannibalism as a Predictor of Oral Squamous Cell Carcinoma - A Histopathologic Correlation.

AIM: Cellular cannibalism is defined as the ability of a cell to engulf another cell of its own type or any other. It has been recognized in various malignancies and is linked well with the aggressiveness, degree of anaplasia, invasiveness and metastatic potential. Literature search fetched up very few studies related to the presence and significance of cannibalism with respect to Oral squamous cell carcinoma [OSCC]. The present study was aimed to detect tumor cell cannibalism in OSCC and to validate its role as a prognosticator of OSCC in relation to metastasis and degree of differentiation. METHOD: 30 histopathologically proven cases, 15 cases each of metastatic OSCC (7 well differentiated OSCC and 8 moderately differentiated OSCC) and non-metastatic OSCC (8 well differentiated OSCC and 7 moderately differentiated OSCC) were included in the study. Quantitative assessment of tumor cell cannibalism was done. The data was analyzed using Mann Whitney test. RESULT: Metastatic OSCC showed higher frequency of cannibalistic cells compared to non-metastatic OSCC. More number of cannibalistic cells were found in moderately differentiated OSCC than well differentiated OSCC in both groups. Moreover, Grade III cannibalism and complex cannibalism was also found to be associated with metastatic, moderately differentiated OSCC exclusively. CONCLUSION: It has been found that higher number of cannibalistic cells were associated with OSCC showing metastasis indicating their aggressive behavior. So, we recommend that quantitative assessment of tumor cell cannibalism should become a part of the routine histopathological examination of OSCC to screen its hostile behavior.

Peripheral ossifying fibroma: A rare case affecting maxillary region.

Focal gingival enlargements are a diverse group of lesions with almost similar clinical presentation but varied etiology and histopathology. The actual cause of peripheral ossifying fibroma (POF) has been debated over many years. POFs are usually seen in childhood and younger ages. There is a slight female predilection. It is usually localized, rarely generalized. Usually, the treatment option is only surgical excision with minimal chances of recurrence. Here, we report a case of POF of the right maxillary posterior region with a review of literature.

Ergonomic Microscope: Need of the Hour.

BACKGROUND: Prolonged use of conventional microscope develops musculo-skeletal injuries like chronic pain syndrome, including shoulder, neck, back aches & fatigue. Since the problems go unnoticed, the injuries can lead to some serious permanent damages. This further leads to a compromise in the health and welfare of the person and the institute. Hence, an understanding about the ergonomics is the need of the hour in this postmodern era. Inspite of few studies and surveys about ergonomics, there is still a steep rise in the musculoskeletal disorders. AIM OF THE STUDY: The aim of our study was to gauge the general awareness of pathologists, microbiologists and oral pathologists towards ergonomics in their profession. MATERIALS AND METHODS: A cross-sectional survey based study was de-signed, which included a questionnaire. The questionnaire included multiple choice questions with four alternatives. Professionals (pathologists, microbiologists and oral pathologists) were included in the survey. Teaching faculty (Professors, Associate Professors and Lecturers) and Post graduate students formed the study group. RESULTS AND OBSERVATIONS: The response to the questionnaire was 100%. Less than 50% of oral pathologists were aware of the importance of ergonomics in their profession. The most common site affected was neck and back. One of the drastic observations was that, Oral Pathologists suffered from a combination of problems affecting neck, back, eyes, headache, shoulders, arms and wrists. CONCLUSION: Increase in our understanding regarding ergonomic-ally designed microscopes can increase our efficiency and in turn improve our general well-being. With improvements in ergonomics, professionals would be able to modify and optimize their working conditions. Certain guidelines need to be followed by the profes-sionals to reduce chances of musculoskeletal disorders.

Congenital granular cell tumor - a rare entity.

Congenital granular cell tumor is a rare benign neoplastic growth affecting the gingival mucosa of neonates. Prenatal ultrasound diagnosis has recently come to focus and in spite of several reports on immune-histochemical and other advanced marker studies, the cause and origin of the lesion remains debatable till date. Review of literature on prenatal diagnosis and histopathology along with immunohistochemistry is discussed.

Quick response code in acrylic denture: will it respond when needed?

Use of acids and other caustic substances in destroying the human body to avoid personal identification is drawing great deal of attention in recent times. With rapid industrial growth, incidence of industrial disasters has increased. In an event of chemical industry disaster, human identification can become a challenge. Embedding bar codes and other electronic means for identification in denture have proved to be a novel innovation in identification of edentulous patients. However, the validity of this method in events of chemical extremes has not been assessed. Hence, the study was undertaken to know the effect of different acids on dentures embedded with quick response codes. Results of this study indicate that simple bar code can be readable up to 33 h after acid treatment. With minimal armamentarium, bar code can be generated incorporating large data into it, providing it to be a cheap and reliable means of denture identification.

Natal and neonatal teeth: an overview of the literature.

The occurrence of natal and neonatal teeth is an uncommon anomaly, which for centuries has been associated with diverse superstitions among different ethnic groups. Natal teeth are more frequent than neonatal teeth, with the ratio being approximately 3 : 1. It must be considered that natal and neonatal teeth are conditions of fundamental importance not only for a dental surgeon but also for a paediatrician since their presence may lead to numerous complications. Early detection and treatment of these teeth are recommended because they may induce deformity or mutilation of tongue, dehydration, inadequate nutrients intake by the infant, and growth retardation, the pattern and time of eruption of teeth and its morphology. This paper presents a concise review of the literature about neonatal teeth.

Dentin dysplasia type I.

Dentin dysplasia type I is a rare hereditary disturbance of dentin formation characterised clinically by nearly normal appearing crowns and hypermobility of teeth that affects one in every 100,000 individuals and manifests in both primary and permanent dentitions. Radiographic analysis shows obliteration of all pulp chambers, short, blunted, and malformed roots, and periapical radiolucencies of non-carious teeth. This paper presents three cases demonstrating classic features of type I dentin dysplasia.

Hybrid peripheral ameloblastoma of cheek mucosa.

An unusual case of large buccal tumour has been described. The lesion was clinically compatible with a squamous cell carcinoma, but it had pathological features of an ameloblastoma arising in the soft tissues. Only few cases of extragingival peripheral ameloblastoma were found in a review of the literature. Possible origins of these tumours are still debatable.