Silver Nanoparticles as an Intracanal Medicament: A Scoping Review.

Silver nanoparticles (AgNPs) release Ag ions with potent bactericidal and anti-inflammatory effects. They have shown promising results as an intracanal medicament for removing Enterococcus faecalis (E. faecalis), a resistant bacterium associated with root canal failures. This review summarizes the role of AgNPs as an intracanal medicament. Original research articles on AgNPs as an intracanal medicament were searched in databases such as MEDLINE (PubMed), Scopus, and Embase, resulting in 24 studies. They showed that AgNPs effectively eliminated E. faecalis and reduced postoperative pain following root canal therapy. However, these effects should be further verified through clinical trials as most of the studies were in vitro.

The Role of Electronic Cigarettes in Dental Caries: A Scoping Review.

Dental caries, a predominant childhood and adolescence affliction, has numerous factors implicated in its pathogenesis. Electronic cigarettes (ECs) have recently gained popularity among the younger population. Various factors, such as the EC liquid composition and aerosols, are associated with the development of dental caries. This review explains numerous EC-related factors which may lead to dental caries. An electronic search was conducted in Medline (Pubmed), Scopus, and Embase databases to evaluate the original research investigating the role of ECs in developing dental caries. About 12 included studies in the review indicated that factors such as the composition of e-liquids and aerosols are significant in the progression of dental caries. Specifically, cariogenic sugars such as sucrose, fructose, glucose, aldehydes, and flavors such as menthol, cinnamon, and strawberry in the e-liquids contribute to dental caries. They are toxic to oral commensals such as Streptococcus gordonii, Streptococcus mitis, Streptococcus intermedius, and Streptococcus oralis and promote the proliferation of cariogenic pathogens such as Streptococcus mutans (S. mutans) which causes dental caries. However, further validation of the effects of ECs on the development of dental caries is warranted through clinical trials.

Evolving Essential and Desirable Requisites for Clinical Fellowship in Cochlear Implant Surgery.

Studies from developed countries show the prevalence of permanent childhood hearing loss to be 1 to 2 per thousand children. The estimated number of Ear, Nose, and Throat (ENT) specialists and otologists in India were 7000 and 2000. There is a great need for trained CI surgeons to care for that burden. Currently, only a handful of centres in the country provide CI training. This study aims to put together essential and desirable requisites for a clinical fellowship in CI surgery for ENT surgeons. A questionnaire was prepared and validated by 25 senior CI surgeons in India. Then the sixteen-question questionnaire was prepared and administered to 100 practising CI Surgeons (Group A) and 100 probable CI Fellowship Candidates (Group B). Group B involved surgeons currently pursuing their ENT post-graduation or have completed their postgraduate training and are inclined towards otology and CI surgery in the future. The responses ranged from 1 (Strongly Disagree) to 5 (Strongly Agree) on a Likert Scale. The responses from both groups were analyzed, and statistical analysis was performed using SPSS(Statistical Package for the Social Sciences) software. The results were analysed and tabulated from both groups. The weighted mean response and mean opinion to all the questions were calculated for both groups. Based on the response, "Essential" and "Desirable" criteria are given.

C3 Targeted Complement Therapy for Chronic Periodontitis - A Scoping Review.

Aim: Chronic Periodontitis (CP) is a complex disease initiated by inflammation caused by dysbiotic bacterial communities in the subgingival environment. The Porphyromonas gingivalis, a keystone pathogen at low colonization, causes immune subversion of complement component C5aR, leading to complement C3-dependent destructive inflammation responsible for the inflammatory bone loss in CP. Animal studies have shown that targeting complement C3 with its inhibitor like AMY-101 may help reduce inflammatory bone loss in CP. This scoping review elaborates on the role of complement C3 targeted therapy for CP. Materials and Methods: About 66 original studies were obtained during an initial electronic search in Medline (Pubmed), Scopus, Web of Science, and Embase. About four articles were included in the review after screening the duplicates and reading the full text. Their aims and objectives, drug dosage, route of administration, results, and conclusions were recorded. Results: Of the four-original research, 3 were animal studies and one randomized Phase IIa clinical trial. They showed that C3 targeted complement therapy reduced the inflammatory and clinical periodontal parameters in CP. Conclusion: C3 targeted complement therapy may be regarded as a valuable adjunct to non-surgical periodontal treatment for CP. However, the results are still under investigation and require further verification through clinical trials.

Bio-Tribocorrosion of Titanium Dental Implants and Its Toxicological Implications: A Scoping Review.

Bio-tribocorrosion is a phenomenon that combines the essentials of tribology (friction, wear, and lubrication) and corrosion with microbiological processes. Lately, it has gained attention in implant dentistry because dental implants are exposed to wear, friction, and biofilm formation in the corrosive oral environment. They may degrade upon exposure to various microbial, biochemical, and electrochemical factors in the oral cavity. The mechanical movement of the implant components produces friction and wear that facilitates the release of metal ions, promoting adverse oro-systemic reactions. This review describes the bio-tribocorrosion of the titanium (Ti) dental implants in the oral cavity and its toxicological implications. The original research related to the bio-tribo or tribocorrosion of the dental implants was searched in electronic databases like Medline (Pubmed), Embase, Scopus, and Web of Science. About 34 studies included in the review showed that factors like the type of Ti, oral biofilm, acidic pH, fluorides, and micromovements during mastication promote bio-tribocorrosion of the Ti dental implants. Among the various grades of Ti, grade V, i.e., Ti6Al4V alloy, is most susceptible to tribocorrosion. Oral pathogens like Streptococcus mutans and Porphyromonas gingivalis produce acids and lipopolysaccharides (LPS) that cause pitting corrosion and degrade the TiO2. The low pH and high fluoride concentration in saliva hinder passive film formation and promote metal corrosion. The released metal ions promote inflammatory reactions and bone destruction in the surrounding tissues resulting in peri-implantitis, allergies, and hyper-sensitivity reactions. However, further validation of the role of bio-tribocorrosion on the durability of the Ti dental implants and Ti toxicity is warranted through clinical trials.

Cochlear Implant in a Child with a Large Arachnoid Cyst and Cysto-peritoneal Shunt.

Profound hearing loss requiring cochlear implantation and arachnoid cyst requiring placement of Cysto-Peritoneal Shunt (CPS) are two commonly seen entities. However, there are very few published cases of patients requiring both of them. The present report describes the importance of multidisciplinary surgical planning in one such patient.

The Role of Zinc Finger Proteins in Various Oral Conditions.

The zinc finger proteins (ZNFs) are essential transcription factors, and the genes encoding them constitute about 3% of the entire human genome. They are involved in the development of several tissues, and any alterations in their structure may promote chronic conditions like diabetes and tumorigenesis. Lately, their role in the development, progression, and metastasis of Oral Squamous Cell Carcinoma (OSCC), Epithelial Dysplasia, Oral Lichen Planus, and Periodontitis has been found. The present review aims to describe their role in various oral conditions. Electronic databases like Medline (PubMed) and Scopus were searched for original studies related to the role of ZNFs in various oral conditions. It yielded 48 studies included in the review. It was found that the ZNFs influenced chronic conditions like Oral Cancer and Periodontitis. They act both as tumor suppressors and oncogenes and have an anti-inflammatory effect. The knowledge from the present review may be utilized in designing drugs that prevent unusual expression of specific ZNFs. Besides, they may be applied as prognostic markers due to their high expression specificity in some tumors.

Evolving a Radiological Protocol for Cochlear Duct Length Measurement: Three Audit Cycles.

To develop an accurate protocol for measuring the Cochlear Duct Length (CDL) by using Multi Detector Computerized Tomography (MDCT) imaging of the temporal bones and thereby make the appropriate choice of electrode for cochlear implantation. 79 MED-EL® Cochlear implantees were divided into three cohorts in chronological order of their implantation. CDL was calculated from MDCT images and correlated with the CDL calculated using the existing Jolly's formula. Results of the CDL measured by unfurling the cochlea correlated well with the existing formula. In addition to CDL measurement, measuring diameter of each turn, especially the apical turn, helped in choosing the appropriate electrode for complete cochlear coverage. Having dedicated radiographers and neuro-radiologists can avoid inter-observer variations in CDL measurements. Measuring the CDL and the diameter of each turn helps in choosing an appropriate electrode thus minimizing intra-operative difficulties and achieving complete safe insertion.

Intra-ductal Foreign Body (Fish Bone Fragment) as a Cause of Obstructive Sialadenitis: A Case Report.

Submandibular sialadenitis is a common ailment in otorhinolaryngological and oral surgical practice. Some of the common causes of sialadenitis include sialolithiasis, inspissated mucous plugs, strictures and anatomical ductal variations. Very rarely do foreign bodies cause obstructive sialadenitis. Fish bone as a foreign body is routinely seen, with the most common locations being oropharynx, hypopharynx, oseophagus and tongue. We report an intriguing case of a 40 year old male with sialadenitis of the right submandibular gland due to an intra-ductal fish bone.

Post-operative hyperleukocytosis and leukostasis as the initial presentation of chronic myelomonocytic leukemia: A case report and review of literature.

Leukemoid reactions following surgery are commonly caused by infections or tissue injury. Management is directed towards underlying condition and cytoreduction is not indicated. Chronic myelo-monocytic leukemia (CMML) is a clonal hematological malignancy characterized by persistent monocytosis and overlapping features of myelodysplastic and myeloproliferative neoplasms.In this case report we describe a 51-year-old Hispanic female without any significant prior medical history, who underwent a cholecystectomy for calculous cholecystitis. Post-operative course was complicated by hyperleukocytosis leading to splenic infarction and intracranial hemorrhage. Further investigations led to a diagnosis of CMML-2. A literature review of patients with CMML who developed post-operative leukocytosis and leukostasis (POLL) is presented.Case high lights two critical points: Post-operative hyperleukocytosis with leukostasis can be the first presentation of CMML Rapid diagnosis and institution of cytoreductive therapy with hydroxyurea is critical to avoid high morbidity and mortality.

Treatment of Primary Mediastinal B-Cell Lymphoma With R-CEOP (Rituximab, Cyclophosphamide, Etoposide, Vincristine, and Prednisone).

Primary mediastinal B-cell lymphoma (PMBCL) is a rare subtype of non-Hodgkin's lymphoma. It typically has an aggressive behavior with potential clinical emergencies including cardiac tamponade, thrombosis of major neck vessels, airway obstruction, and tumor lysis syndrome. In this case report, a 38-year-old Caucasian male presented with shortness of breath, a two-month history of 40-pound weight loss, and a left-sided chest wall mass. CT imaging showed a mediastinal mass, measuring 13 × 14.6 × 8.6 cm3, with invasion and partial occlusion of the brachiocephalic veins and upper superior vena cava causing superior vena cava syndrome, and encasement of multiple coronary artery segments. CT-guided biopsy showed high-grade B-cell lymphoma. Cytology biomarkers were positive for CD20, CD45, and PAX5. A trans-thoracic echocardiogram (TTE) was obtained prior to chemotherapy initiation to establish a baseline for cardiac function, which showed an ejection fraction (EF) of 45-50%, right ventricle volume overload and dilation, and pulmonary hypertension. R-CEOP (rituximab, cyclophosphamide, etoposide, vincristine, and prednisone) chemotherapy regimen was initiated and a follow-up echocardiogram after three cycles, revealed a significant improvement in EF; the patient subsequently received three additional cycles of R-EPOCH. Current regimens in the United States utilize dose-adjusted R-EPOCH and R-CHOP, but they must be used cautiously in patients with compromised cardiac function, due to the cardiotoxic side effects of the chemotherapy agent, doxorubicin. This case illustrates that anthracycline-free regimens should be considered in patients with reduced cardiac function, with this case showing the utilization of an anthracycline-free regimen (R-CEOP) for the first three cycles, followed by a transition to R-EPOCH.

Application of Adipose Tissue Stem Cells in Regenerative Dentistry: A Systematic Review.

AIM: The aim of this study was to systematically review the applications of adipose tissue stem cells (ADSCs) in regenerative dentistry. MATERIALS AND METHODS: An electronic search was conducted in Medline (PubMed) and Scopus databases. The original research associated with the role of ADSCs in regeneration of alveolar bone, periodontal ligament (PDL), cementum as well as the dental pulp was evaluated. Among the included studies, three animal studies and one human study had low risk of bias. RESULTS: A total of 33 relevant studies were included in the review. The animal models, in vivo human, and in vitro studies revealed that ADSCs had a significant osteogenic differentiation potential. Besides, they had potential to differentiate into PDL, cementum, and dental pulp tissue. CONCLUSION: The ADSCs may be specifically applied for bone tissue engineering in the management of alveolar bone defects, specifically in dental implants and periodontal disease. However, their role in regeneration of PDL, cementum, and dental pulp requires further investigations. Overall, their applications in regenerative dentistry needs further verification through human clinical trials.

Ethnic and border differences on blood cancer presentation and outcomes: A Texas population-based study.

BACKGROUND: The Texas/Chihuahua (US/Mexico) border is a medically underserved region with many reported barriers for health care access. Although Hispanic ethnicity is associated with health disparities for many different diseases, the population-based estimates of incidence and survival for patients with blood cancer along the border are unknown. The authors hypothesized that Hispanic ethnicity and border proximity is associated with poor blood cancer outcomes. METHODS: Data from the Texas Cancer Registry (1995-2016) were used to investigate the primary exposures of patient ethnicity (Hispanic vs non-Hispanic) and geographic location (border vs non-border). Other confounders and covariates included sex, age, year of diagnosis, rurality, insurance status, poverty indicators, and comorbidities. The Mantel-Haenszel method and Cox regression analyses were used to determine adjusted effects of ethnicity and border proximity on the relative risk (RR) and survival of patients with different blood cancer types. RESULTS: Hispanic patients were diagnosed at a younger age than non-Hispanic patients and presented with increased comorbidities. Whereas non-Hispanics had a higher incidence of developing blood cancer compared with Hispanics overall, Hispanics demonstrated a higher incidence of acute lymphoblastic leukemia (RR, 1.92; 95% CI, 1.79-2.08; P < .001) with worse outcomes. Hispanics from the Texas/Chihuahua border demonstrated a higher incidence of chronic myeloid leukemia (RR, 1.28; 95% CI, 1.07-1.51; P = .02) and acute myeloid leukemia (RR, 1.17; 95% CI, 1.04-1.33; P = .0009) compared with Hispanics living elsewhere in Texas. CONCLUSIONS: Hispanic ethnicity and border proximity were associated with a poor presentation and an adverse prognosis despite the younger age of diagnosis. Future studies should explore differences in disease biology and treatment strategies that could drive these regional disparities.

Association Between Tumor Mutation Profile and Clinical Outcomes Among Hispanic-Latino Patients With Metastatic Colorectal Cancer.

In the United States, CRC is the third most common type of cancer and the second leading cause of cancer-related death. Although the incidence of CRC among the Hispanic population has been declining, recently, a dramatic increase in CRC incidents among HL younger than 50 years of age has been reported. The incidence of early-onset CRC is more significant in HL population (45%) than in non-Hispanic Whites (27%) and African-Americans (15%). The reason for these racial disparities and the biology of CRC in the HL are not well understood. We performed this study to understand the biology of the disease in HL patients. We analyzed formalin-fixed paraffin-embedded tumor tissue samples from 52 HL patients with mCRC. We compared the results with individual patient clinical histories and outcomes. We identified commonly altered genes in HL patients (APC, TP53, KRAS, GNAS, and NOTCH). Importantly, mutation frequencies in the APC gene were significantly higher among HL patients. The combination of mutations in the APC, NOTCH, and KRAS genes in the same tumors was associated with a higher risk of progression after first-line of chemotherapy and overall survival. Our data support the notion that the molecular drivers of CRC might be different in HL patients.

Applications of Teriparatide for Alveolar Bone Regeneration: A Systematic Review.

AIM: The aim of this study was to systematically review the applications of teriparatide (TP) for alveolar bone regeneration in oral cavity. MATERIALS AND METHODS: An electronic search of the data was conducted in Medline (PubMed), Scopus, Web of Science, and Embase. The original research associated with the applications of TP for alveolar bone regeneration was evaluated. Cochrane's tool [for human randomized controlled trials (RCTs)] and SYRCLE's tool (for animal RCTs) were used to assess the risk of bias. About two human and four animal studies had low risk of bias. RESULTS: The results from the 11 studies that were included in the review showed that TP enhanced alveolar bone formation in osteonecrosis of jaws, chronic periodontitis (CP), osseointegration of dental implants as well as orthodontic tooth movement. CONCLUSION: The TP may be applied for alveolar bone regeneration in osteonecrosis of jaws and CP. However, further human clinical trials are required to verify its applications and adverse effects in various oral bone conditions.

Discordant PET Findings and a High Relapse Rate Characterize Hispanics With Hodgkin's Lymphoma Treated With ABVD.

Background: Population-based studies on Hodgkin's lymphoma (HL) have shown reduced survival in Hispanics and non-Hispanic Blacks compared with non-Hispanic Whites. To better understand the factors contributing to this outcome discrepancy, we retrospectively reviewed the charts of patients with HL diagnosed and treated at a single institution located along the Texas-Mexico border. Patients and Methods: We performed a retrospective chart review of all patients with HL treated at our institution over an 8-year period (2011-2018). The International Prognostic Score was calculated for all patients and results of positron-emission tomography (PET) scans (interim and end of treatment) were also recorded. Variables analyzed included tumor-related findings (stage, subtype of HL), treatment history (chemotherapy regimen including number of cycles, dose intensity and radiation treatments) and neutrophil to lymphocyte ratio. Quantitative variables were described using median, interquartile range, minimum and maximum observations. Categorical variables were described using frequency and proportions. Kaplan-Meier curves were used to show relapse-free survival. Results: A total of 24 patients were treated in the time frame, of whom 23 were Hispanic. All were treated with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) or an ABVD-like regimen. Dose intensity for chemotherapy exceeded 90%. After a median follow-up of 43 months, the relapse rate was 45.8%. Positive and negative predictive values for interim PET (0% and 50%) and end of therapy PET (80% and 58%) were suboptimal to allow for a PET-adapted therapeutic approach. Conclusion: Hispanics have a high relapse rate following ABVD which is not fully explained by universally accepted prognostic factors. Performance of PET scan in predicting outcomes of HL needs to be further studied and optimized before adopting a PET-adapted treatment paradigm for underserved Hispanic populations.

Exfoliative Dermatitis as a Para-neoplastic Syndrome of Prostate Adenocarcinoma: A Rare Case Report With Literature Review.

Background/Aim: This study aimed to report a rare case of erythroderma or exfoliative dermatitis as a paraneoplastic syndrome of prostate adenocarcinoma. Exfoliative dermatitis is a rare inflammatory skin condition that is characterized by desquamation and erythema involving more than 90% of the body surface area. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. Case Report: Herein we report a case of 55-year-old male patient who presented with progressively diffuse scaling and erythematous rash of 3 months duration. He was diagnosed with untreated prostate adenocarcinoma about 2 months prior his admission. Skin biopsy confirmed exfoliative erythroderma diagnosis. He was investigated extensively for other pathologies, however all work up remained negative except a CT finding of large heterogeneous prostate gland with elevated PSA which was consistent with prostate cancer. Daily oral prednisone for one week and hydrocortisone cream provided partial clinical improvement. The patient was discharged on tapering steroid to follow-up with urology and oncology for further underlying prostate carcinoma management. Conclusion: We concluded that the ongoing erythroderma was a paraneoplastic syndrome of prostate adenocarcinoma. Hence, early detailed history and routine screening of malignancy-related biomarkers is warranted on any individuals presenting with such symptoms.

Acute aleukemic mast cell leukemia: Report of a case and review of the literature.

Mast Cell Leukemia (MCL) is the rarest form of systemic mastocytosis, a rare group of neoplastic disease that result from clonal proliferation of mast cells and their accumulation in one or more organ systems. The diagnosis of MCL is made by meeting the World Health Organization (WHO) 2017 criteria. MCL is further subclassified as leukemic or aleukemic based on presence or absence of circulating mast cells in the peripheral blood and acute versus chronic based on presence or absence of findings indicative of impaired organ function due to mast cell infiltration. A 64-year-old Hispanic male presented with myalgia, diarrhea, urticarial rash, back pain, and fulminant disseminated intravascular coagulation. Bone marrow examination, supplemented by immunohistochemistry results, fulfilled the WHO criteria for the diagnosis of MCL. To the best of our knowledge, this is the first documented case of aleukemic acute MCL in a Hispanic patient.

Tumor Lysis Syndrome After a Single Dose of Atezolizumab with Nab-Paclitaxel: A Case Report and Review of Literature.

BACKGROUND Tumor lysis syndrome (TLS) represents a severe and dangerous side effect of chemotherapy. The frequency of TLS is not well known in patients with breast cancer, and there are no reports of TLS after the second or third lines of chemotherapy or immunotherapy combined with chemotherapy in these patients. CASE REPORT We present the case of a 55-year-old postmenopausal woman with metastatic triple-negative breast cancer who received multiple lines of chemotherapy and developed TLS after receiving combined chemoimmunotherapy. She presented to our medical center with generalized body weakness, sleepiness, anorexia, and oliguria 6 days after her first dose of combined chemoimmunotherapy with nanoparticle albumin-bound (nab)-paclitaxel (100 mg/m²) and atezolizumab (840 mg). A complete blood count on admission showed pancytopenia, with serum levels of uric acid at 17.8 mg/dL, creatinine at 3.4 mg/dL, potassium at 5.5 mEq/L, phosphorus at 5.0 mg/dL, and calcium at 9.3 mg/dL. TLS (grade 2) was diagnosed based on reported Cario-Bishop criteria, and the patient was promptly treated with intravenous hydration and a single dose of rasburicase (0.15 mg/kg). Symptoms completely resolved within 4 days, and the patient was discharged home. CONCLUSIONS We present a case of TLS after combined therapy with atezolizumab and nab-paclitaxel in a heavily pretreated patient with metastatic triple-negative breast cancer. Medical oncologists and general practice clinicians need to be aware of the possibility of TLS, even in unlikely cases, and to recognize the clinical signs of TLS to enable prompt and appropriate management.

Remarkable response to combined immunochemotherapy in patients with metastatic triple-negative breast cancer.

Background: Progress in immunotherapy (IT) has shifted treatment paradigms for multiple malignancies. In March 2019, the combination of nab-paclitaxel and atezolizumab was approved by the US FDA for patients with PD-L1 positive metastatic triple-negative breast cancer based on positive results of the Impassion130 trial. Although numerous studies have examined the prognostic role of PD-L1, the value of this test remains controversial. Results: Here, we presented the cases of three heavily pretreated women with metastatic triple-negative breast cancer who exhibited remarkable responses to combined IT and chemotherapy despite undetectable PD-L1. Conclusion: In our opinion, the current FDA-approved assessment for PD-L1 expression is a reasonable tool for deciding whether to start IT. However, because this approach has many limitations, patients with undetectable PD-L1 expression should still be considered for IT.