Analysis of Discrepancy Index between Clinical and Histopathological Diagnosis of Oral Lesions.

OBJECTIVE: To analyze the discrepancy index between the clinical and histological diagnosis of oral lesions. MATERIALS AND METHOD: A sample of 910 cases from year 2013-2021 were analyzed using non probability convenience sampling technique. This included patient records and histopathological reports of patients treated at IIDC & H and FUCD & H. Clinical presentations were classified under five categories; growth/swelling, vesico-ulcerative, white, red/pigmented, and cystic lesions. To evaluate the details of diagnostic discrepancies, the data was categorized into 4 major groups: 1) Neoplastic-Neoplastic,2) Non-Neoplastic-Non-Neoplastic ,3) Neoplastic-Non-Neoplastic and 4) Non-Neoplastic-Neoplastic. The association between clinical diagnosis and histopathological diagnosis was calculated by using pearson chi square test and statistical significance was considered with the p value less than (0.05). RESULTS: Most common clinical presentation was swelling/growth; 601 (66%), followed by ulceration; 223 (24.5%). There were 528 (58%) incisional and 382 (42%) excisional biopsies. The definitive diagnosis based on histopathological findings showed malignant neoplasms as the commonest category; 287 (31.5%) followed by inflammatory/reactive lesions 271 (29.8%). A consensus was noted between the clinical and histologic diagnosis in 74.8% cases, while a discrepancy index of 25.1 % was calculated. Regarding diagnostic discrepancy among four major categories of our research, maximum discrepancy was noted in neoplastic-nonneoplastic category (29.6%) and minimum discrepancy was noted in malignant - benign category (2.7%).  Statistically significant difference between the clinical and histopathological diagnosis was observed with a p value of 0.000. CONCLUSION: Considerable amount of diagnostic discordance was observed in all types of pathologies analyzed in the study.

Recent Updates on Peptide Molecules in Drug and Vaccine Development.

Peptides are of great importance in the areas of science because they can act as drug carriers and their therapeutic effect and their ability to generate an immune response. As culturing of viral agents for drugs and vaccine development is harmful, therefore, peptide-based drugs and vaccines have achieved great importance. Large immunoglobulins cannot pass the plasma membrane, so peptides are used to study this interaction because of their small size. Peptides with substituted amino acid sequences are also stable in blood serum, which makes them significant for drug development. Peptides with substituted amino acid sequences are stable in blood serum hence, their stability, small size, easy screening, cost-effectiveness, ease of administration and particularity (target specificity) make them effective to be used in pharmaceutical companies. Mostly branched peptides are used for the development of drugs because they are not prone to be degraded by proteolytic enzymes. In peptide-based vaccines, protein acts as the main constituent from which the main component that causes the infection is deleted by recombinant DNA technology, and these peptides act as antigens to stimulate the immune response. Self-assembled peptides have the main role in the delivery of drugs and vaccine molecules inside the living cells because they may also assemble into nano technological structures to improve their efficiency. This review focuses on the characteristics of peptides that make them effective to develop drugs and vaccines. Different peptides like synthetic peptides, antimicrobial peptides, signal peptides, carrier peptides, and their role against various viral, pathogenic, and microbial diseases and in cosmetics are described briefly.

Mesorhizobium improves chickpea growth under chromium stress and alleviates chromium contamination of soil.

Environmental pollution has become a transnational issue that impacts ecosystems, soil, water, and air and is directly related to human health and well-being. Chromium pollution decreases the development of plant and microbial populations. It warrants the need to remediate chromium-contaminated soil. Decontaminating chromium-stressed soils via phytoremediation is a cost-effective and environmentally benign method. Using multifunctional plant growth-promoting rhizobacteria (PGPR) lower chromium levels and facilitates chromium removal. PGPR work by altering root architecture, secreting chemicals that bind metals in the rhizosphere, and reducing phytotoxicity brought on by chromium. The present study aimed to investigate the chromium bioremediation capacity of metal-tolerant PGPR isolate while promoting the growth of chickpeas in the presence of varying levels of chromium (15.13, 30.26, and 60.52 mg/kg of chromium). The isolate, Mesorhizobium strain RC3, substantially reduced chromium content (60.52 mg/kg) in the soil. It enhanced the root length by 10.87%, the shoot length by 12.38%, the number of nodules by 6.64%, and nodule dry weight by 13.77% at 90 days. After 135 days of sowing, more improvement in the root length (18.05), shoot length (21.60%)the chlorophyll content (6.83%), leghaemoglobin content (9.47%), and the highest growth in the crop seed yield (27.45%) and crop protein content (16.83%)The isolate reduced chromium accumulation in roots, shoots, and grains chickpea. Due to chromium bioremediation and its plant growth-promoting and chromium-attenuating qualities, Mesorhizobium strain RC3 could be used as a green bioinoculant for plant growth promotion under chromium stress.

Apparatus for Automated Continuous Hydrogen Deuterium Exchange Mass Spectrometry Measurements from Milliseconds to Hours.

Hydrogen deuterium exchange mass spectrometry (HDX-MS) is a rapidly growing technique for protein characterization in industry and academia, complementing the "static" picture provided by classical structural biology with information about the dynamic structural changes that accompany biological function. Conventional hydrogen deuterium exchange experiments, carried out on commercially available systems, typically collect 4-5 exchange timepoints on a timescale ranging from tens of seconds to hours using a workflow that can require 24 h or more of continuous data collection for triplicate measurements. A small number of groups have developed setups for millisecond timescale HDX, allowing for the characterization of dynamic shifts in weakly structured or disordered regions of proteins. This capability is particularly important given the central role that weakly ordered protein regions often play in protein function and pathogenesis. In this work, we introduce a new continuous flow injection setup for time-resolved HDX-MS (CFI-TRESI-HDX) that allows automated, continuous or discrete labeling time measurements from milliseconds to hours. The device is composed almost entirely of "off-the-shelf" LC components and can acquire an essentially unlimited number of timepoints with substantially reduced runtimes compared to conventional systems.

Diagnostic and prognostic role of cancer stem cell biomarkers in oral squamous cell carcinoma; A Systematic Review.

Objectives: To evaluate the role of cancer stem cell biomarkers in diagnosis and prognosis of OSCC patients. METHODS: The search strategy was entered into PubMed NLM, EBSCO CINAHL, EBSCO Dentistry & Oral Sciences Source, Wiley Cochrane Library, and Scopus. The full text eligible studies (n=7) were assessed for their quality using the JBI Critical Appraisal Checklist to evaluates the methodological quality of the studies based on possibility of bias in its design, conduct, and analysis. Selected studies were further analysed based on different parameters such as publication year, sample size, and outcomes. RESULTS: A total of 432 studies were identified through the search strategy. A total of 306 records were removed before screening either because of duplication or marked ineligible by the automation tools. The screened records were 126 out of which 104 were removed as they were not conducted on OSCC. Twenty-two reports were sought for retrieval, however, we could not find the full text of 3 studies and12 studies were excluded because the biomarkers were not associated with cancer stem cells. The most common cancer stem cell biomarkers associated with OSCC were MCT1,VEGF-A, GD15, HIF1 α, Ki67, Hsp 70, Cyclin D1, and CD44. CONCLUSIONS: Various stem cell biomarkers have been found to have diagnostic and prognostic role in oral squamous cell carcinoma such as Cyclin D1, VEGF-A, GD15, and CD44. They can be used to predict the overall survival rate, local progression-free survival rate, and distant metastasis-free survival rate in Head and Neck cancer patients.

Estimating the Need for Sedation in Patients with Dental Anxiety and Medical Complexities Reporting to Tertiary Care Dental Hospital Using the IOSN Tool.

Objectives: To provide consistent method for assessment of sedation need among patients undergoing dental treatment based on specific risk factors that is dental anxiety, medical status, and treatment complexity of needed dental treatment using IOSN (indication of sedation need) tool for assisting the clinician in decision making process. Methods: A total of 237 patients aged ≥12, ASA I and II were enrolled in the study. A structured questionnaire comprising of three sections was distributed among the participants. Section 1 comprises details about age, gender, literacy level, occupation, monthly income, and previous dental treatment history. Section 2 is based on Modified Dental Anxiety Scale which is a questionnaire comprising of five questions ranging from "not anxious" to "extremely anxious." The third section was based on using the IOSN tool comprising three components: MDAS (Modified Dental Anxiety Scale) rank score, Systemic Health (ASA status) rank score, and treatment complexity rank scores. The total of three scores was then computed to determine the total rank score which suggested the sedation need. History of past traumatic dental experiences was also inquired from each patient. Results: A total of 237 patients aged ≥12, ASA I and II were enrolled in the study, out of which 56.1% were female. Statistical analysis was conducted by using the IBM SPSS Statistics 23 software. Based on the MDAS score, 47/237 (19.8%) participants were found to be highly anxious related to dental procedures. 34.6% of the participants showed to have a high sedation need while performing a dental procedure. The sedation need was found to be significantly associated with the female gender with a significant p value of (p=0.016), higher education status (p=0.016), and history of previous traumatic dental experience (p < 0.001). Conclusion: A simple assessment tool can enable clinicians in their decision making to identify patients in need for dental treatment under sedation based on patient-specific risk factors such as past traumatic dental experiences. Need for sedation can be assessed by information on patient anxiety level towards dental treatment, medical history, and complexity of planned dental treatment. The IOSN tool is a simple and quick assessment tool that can be applied for preprocedural assessment of sedation need for dental treatment.

Ecological risk assessment of heavy metal chromium in a contaminated pastureland area in the Central Punjab, Pakistan: soils vs plants vs ruminants.

Grazing animals act as a bioindicator to study the heavy metal status in the pasture lands because excessive amount of toxic metals in the animal diet either disturb their normal activity or deposit the contaminants into their tissues. The aim of this study was to appraise the chromium status in soil and pasture crops with respect to the nutritional requirement of grazing animals. Three different sites were selected to collect soil, forages, and animal samples from District Jhang. All the samples were processed through atomic absorption spectrophotometer to analyze the chromium concentration in them. Chromium concentration was varied as 0.703-4.20 mg/kg in soil, 0.45-2.85 mg/kg in forages, and 0.588-2.37 mg/kg in all collected animal samples. Both the soil and forage samples displayed the maximum chromium concentration in the Capparis decidua, whereas animal samples revealed maximum concentration in animal blood. Results of pollution load index (0.078 to 0.463 mg/kg) exhibited that all the sample values are less than unity while enrichment factor (1.57-8.25mg/kg) showed that significant level of chromium is enriched in these sites. The maximum value of daily intake (0.0007-0.0055mg/kg/day) and health risk index (0.0004-0.00370055mg/kg/day) was observed in the buffalo that feed on the Capparis decidua. Bio-concentration factor (0.398-2.09mg/kg) value was the maximum in the Medicago sativa. It is concluded that all the animal samples showed chromium concentration beyond their standards. Thus, proper measures should be taken to reduce the metal contamination in these areas that ultimately lessen the availability of toxic metals to grazing animals.

Evaluation of potential ecological risk and prediction of zinc accumulation and its transfer in soil plants and ruminants: public health implications.

Present work evaluated the zinc (Zn) concentration in soil, forage, blood plasma, hair, and feces samples of cows, buffaloes, and sheep taken from Mianwali, Punjab, Pakistan. The concentration of Zn was found in the ranged of 21.82-35.09mg/kg, 32.59-42.17mg/kg, 0.927-2.48mg/l, 1.03-2.84mg/kg, and 0.923-1.98mg/kg in soil, forage, blood plasma, hair, and feces samples, respectively. The Zn concentration in soil, forage, blood, hair, and feces was safer compared to standard limits. Statistical analysis described that values for BCF, PLI, EF, DIM, and HRI ranged 1.03-1.57mg/kg, 0.486-0.782mg/kg, 0.457-0.696mg/kg, 0.048-0.08mg/kg, and 0.160-0.272mg/kg, respectively. It can be concluded from the present work that Zn concentration was safe in soil, forages, and animal samples. BCF was noticed as greater than 1 while PLI, EF, DIM, and HRI were found less than 1, so regular heavy metal analysis was required to appraise the contamination level in environment.

Quantitative evaluation of zinc metal in meadows and ruminants for health assessment: implications for humans.

Heavy metal pollution in soil, forage, and animals is serious concern nowadays. Current research was conducted in Sargodha to find out the relationship of animals related to the forages and soil pollution. Three sites were selected with three different treatments; site I irrigated with ground water, site II irrigated with the canal water, and site III irrigated with the wastewater. Samples of soil, forage, and animals (blood, hair, feces) were collected from selected sites and were analyzed for metal analysis using atomic absorption spectroscopy. Results indicated that Zn in soil ranged from 24.12 to 37.39 mg/kg; forage, 31.98-44.47 mg/kg; blood of animals, 1.49-2.72 mg/L; hair of animals, 1.37-2.41 mg/kg; and feces of animals, 1.06-2.97 mg/kg. The concentration of zinc in soil and forage was less than permissible limit, but concentration in blood of animals was greater than critical limit suggesting the presence of metal. Bio-concentration factor indicated that metal was accumulated in forages growing at irrigated site. HRI concentration (2.024 mg/kg/day) suggests the accumulation of zinc in animal tissues. Pollution load index and enrichment factor were within the range.

Elucidating the inherent features of IS to better understand idiopathic scoliosis etiology and progression.

Idiopathic Scoliosis (IS) is a relatively common condition and is estimated to affect as many as 3 % of youth aged 10-17 years (in the United States an estimated approximately 1.4 million otherwise healthy individuals). A clear understanding of the etiology will better direct optimization of evaluation, treatments and therapies, especially early treatments with less invasive methods. A mechanistic explanation of factors combining to initiate and then cause progression of this common condition-- in otherwise healthy pre-teenage and teenage patients--will be discussed. A recent well-designed structured systematic review states that 'strong evidence is lacking for a consistent pattern of occurrence and any abnormality', in other words there is no strong evidence for 'other associated diagnoses' in IS. And so, certain important inherent factors of IS merit greater discussion. Inherent, or intrinsic factors include: a natural susceptibility to develop a lateral and rotational deformity in the immature rapidly growing erect human spine, inherent torsion associated at the induction of deformity, biomechanics related to curve progression, and anthropology/bipedal gait. We know more today about factors related to the condition and its etiology than we have previously. Across multiple disciplines, a mechanistic approach to understanding the etiopathogenesis of IS, allows a reasonable 'theory' for IS etiology and its progression. We will discuss these inherent intrinsic factors in order to further add to our understanding of the theoretical etiopathogenesis. A better understanding of the etiology (and progression) may better direct ways to optimize evaluation, treatments and therapies, especially early treatments with less invasive methods.

IS (Idiopathic Scoliosis) etiology: Multifactorial genetic research continues. A systematic review 1950 to 2017.

OBJECTIVE: IS (idiopathic scoliosis) is a common spinal condition occurring in otherwise completely healthy adolescents. The root cause of IS remains unclear. This systematic review will focus on an update of genetic factors and IS etiology. Though it is generally accepted that the condition is not due to a single gene effect, etiology studies continue looking for a root cause including genetic variants. Though susceptibility from multiple genetic components is plausible based on known family history data, the literature remains unclear regarding multifactorial genetic influences. The objective of this study was to critically evaluate the evidence behind genetic causes (not single gene) of IS through a systematic review and strength-of-study analysis of existing genetic and genome-wide association studies (GWAS). We used the protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). METHODS: PubMed was searched for the terms IS, scoliotic, spinal curve, genetic, gene, etiology, polymorphisms. Articles were assessed for risk-of-bias. Level-of-evidence grading was completed via Oxford Centre for Evidence-Based Medicine criteria. The assessment scores factor strength of a study in determining a positive or negative association to a gene etiology. RESULTS: After screening of 36 eligible papers, 8 relevant studies met inclusion criteria at this time, 3 were in favor of a genetic factor for IS, whereas 5 studies were against it. CONCLUSION: Based on the literature analyzed, there is moderate evidence with a low risk-of-bias that does not clarify a genetic cause of IS. The 2 studies in favor of a genetic etiology were completed in homogeneous populations, limiting their generalizability. Relying on a genetic etiology alone for IS may over simplify its multifactorial nature and limit appreciation of other influences.

Idiopathic scoliosis: A pilot MR study of early vertebral morphological changes and spinal asymmetry.

Adolescent idiopathic scoliosis (AIS) a common spinal condition affecting adolescents. Though the etiology is still unknown, it is widely thought to have a multifactorial etiology and early diagnosis remains a significant challenge. The purpose of this study is to identify early vertebral morphological changes and patterns of spinal asymmetry in these at-risk individuals who later progress to adolescent idiopathic scoliosis. This was a retrospective study of patients treated for AIS between 1997 and 2017. We utilized two study groups, a group with immature onset of spinal asymmetry and a control group. Inclusion criteria for the immature onset group was defined by a Cobb angle between 10 and 40° diagnosed prior to the age of 12 with MRI scans and XRs available for review. Qualitative assessments observed for sagittal vertebral wedging, analysis of vertebral corner anatomy, spinal harmony, and sagittal balance. These findings were then qualitatively compared between groups. Twenty patients were included in this study, ten each in the immature onset and control groups. In the immature onset group, two patients had sagittal wedging, five had abnormal vertebral corners, nine did not have spinal harmony, and nine had negative sagittal balance, compared to none of the control patients having sagittal wedging, none having abnormal vertebral corners, all having spinal harmony, and nine having positive spinal balance. This pilot MRI study identifies qualitative vertebral morphological changes in patients who progress to AIS. Our findings suggest abnormal vertebral corner anatomy, sagittal wedging, and negative sagittal balance as potential early findings in patients who develop AIS.

Oral white lesions: presentation and comparison of oral submucous fibrosis with other lesions.

OBJECTIVE: To compare oral submucous fibrosis with other white oral lesions for presentation and associated factors. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Departments of Oral Medicine and Oral and Maxillofacial Surgery, Dr. Ishrat-ul-Ibad Institute of Oral Health Sciences (DIKIOHS), Karachi, from May 2008 to May 2009. METHODOLOGY: Patients presenting with oral white lesions were selected by consecutive non-purposive sampling and clinico-demographic data was collected. For patients with oral submucous fibrosis (OSF), additional information like duration of habits, maximal incisal opening (MIO), presence of any other associated lesion were noted. OSF was compared with other white lesions for any association between characteristic of subjects. Chi-square and independent t-tests for determining the statistical significance at p < 0.05. RESULTS: OSF was present in 59.6% (n = 106) of the 178 patients; other white lesions were 40.4% (n = 72). The mean age of patients with OSF was 34 ± 12.7 years and 45.81 ± 16.2 years in patients with other white lesions, (p < 0.0001).Items containing areca nut were consumed more by patients with OSF, with a significant (p < 0.0001) compared to patients with other white lesions. CONCLUSION: OSF was the predominant white lesion in patients examined at DIKIOHS. Areca nut was found to be chewed more by patients with OSF and still longer by patients with SCC.

Etiology and pattern of maxillofacial injuries in the Armed Forces of Pakistan.

OBJECTIVE: To determine the etiology and pattern of maxillofacial injuries in the Armed Forces of Pakistan in terms of anatomical distribution of injuries. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: January 2001 to Jan 2004 at the Oral and Maxillofacial Surgery Department, AFID, Rawalpindi. PATIENTS AND METHODS: Three hundred consecutive patients of Armed Forces of Pakistan with maxillofacial injuries reporting to AFID and admitted to the hospital or treated as out-patients in the oral surgery clinic, were included in this study. Isolated nasal bone and frontal sinus fractures were excluded from the study. Anatomical distribution, frequency and etiology of fractures, rank at job and occupational as well as personal hobbies were recorded. Descriptive analyses were used to determine mean, standard deviation, percentage and range values. RESULTS: The most frequent bone fractured was the mandible, which accounted for 159 cases (53%). The zygomatic complex was fractured in 51 cases (17%), the maxilla in 12 cases (4 %), and the alveolar process in 21 cases (7%). The most common cause was road traffic accident (168 cases; 56%), followed by accidental fall (69 cases; 23%), gunshot injuries (27 cases; 9%), sports related injuries (15 cases; 5%), and injury associated with a fight (12 cases; 4%); there were only 9 cases of animals related injuries (3%). CONCLUSION: In this series, mandible was the most commonly fractured facial bone, while road traffic accident was the most common etiological factor. Results could be influenced by the personal and working environment.