Risk Factors for Meibomian Gland Disease Assessed by Meibography.

Purpose: To elucidate risk factors for meibomian gland disease (MGD) and understand associated changes in meibography and in relation to ocular surface disease. Patients and Methods: As part of the standard workup for ocular surface disease at a tertiary academic center, 203 patients received an ocular history and lifestyle questionnaire. The questionnaire included detailed inquiries about ocular health and lifestyle, including makeup use, cosmetic eyelid procedures, screen time, and contact lens habits. Subjects also took the standardized patient evaluation of eye dryness (SPEED) II questionnaire. Meibomian gland (MG) dropout and structural changes were evaluated on meibography and scored by three independent graders using meiboscores. Statistical analysis was conducted to identify significant risk factors associated with MG loss. Results: This retrospective, cross-sectional study included 189 patients (378 eyes) with high-quality images for grading, and the average age was 67 years (77% female). Patients older than 45 years had significantly more dropout than younger patients (p < 0.01). Self-reported eye makeup use did not significantly impact MG loss. Patients with a history of blepharoplasty trended toward higher meiboscores, but the difference was not statistically significant. Self-reported screen time did not affect meiboscores. Contact lens use over 20 years was associated with significant MG loss (p < 0.05). SPEED II scores had no relationship to meiboscores (p = 0.75). Conclusion: Older age is a significant risk factor for MG loss. Any contact lens use over 20 years also impacted MG dropout. Highlighting the incongruence of symptoms to signs, SPEED II scores showed no relationship to the structural integrity of MGs.

Expression of CD 20 B-Lymphocyte in oral epithelial dysplasia and oral squamous cell carcinoma: A comparative immunohistochemistry study.

Background: As the progressive trends in the field of immunotherapy, it is very favourable to reconsider the role played by B lymphocytes in the tumor microenvironment. Both the protumorogenic and antitumorogenic responses have to be evaluated to formulate an effective immunotherapeutic protocol. Aim and objective: The study was primarily conducted to assess the qualitative expression of B lymphocytes in pretumorogenic (oral epithelial dysplasia) and tumorogenic environment (oral squamous cell carcinoma). The differential immunohistochemical staining of CD 20 immune marker was assessed in about 60 cases that included 30 cases of oral epithelial dysplasia and 30 cases of oral squamous cell carcinoma. Results: The study found significant correlation between CD 20 IHC immune expression and histopathological diagnosis along with significant correlation between the subject's age group and histopathological diagnosis. Conclusion: Modulating the immune response in a precancerous state can be highly beneficial in implementing better immunotherapeutic strategies to treat or prevent malignancy at an early stage.

Myofibroma of mandibular alveolus: A case report.

Phenotypic heterogeneity has been a complex phenomenon lately, fetching attention in tumour pathology. Myofibroblastic differentiation is one such example and, besides, functional heterogeneity contributes to the biological behaviour of the tumours. Myofibroma is a distinctive neoplasm of myofibroblasts with a low incidence rate in the oral cavity. A case of myofibroma in mandibular alveolus in an adult patient is reported here for its rarity and diagnostic dilemma.

Site specificity and expression profile of miR-21 in oral squamous cell carcinoma.

BACKGROUND: Oral Squamous Cell Carcinoma (OSCC) is the most common epithelial malignancy of the oral cavity which has evolved globally as a grave and growing health problem. It shares a wide geographic variation with respect to the incidence rate and exhibits anatomic adaptation to oral environment with varied clinical presentation along with a spectrum of histological mélange. Besides, in recent cancer research, both genetics and epigenetics add on at the molecular level and accounts for this diversification and tumor heterogeneity of OSCC and thereby substantiates to the miRNA expression profiling in OSCC. AIMS AND OBJECTIVES: In the present study, subsite specificity of miR-21 expression in tissue specimens of OSCC of Tongue, Buccal mucosa, and Gingivo buccal (GB) sulcus were analyzed. MATERIALS AND METHODS: Quantification of miR-21 was done on 30 tissue samples of OSCC using real-time polymerase chain reaction (RT-PCR). RESULTS: Results indicated that miR-21 expression was significantly expressed at the subsites. Out of 30 samples, 22 showed upregulation, and 8 showed down-regulation with reference to endogenous control. The comparative Ct method was used to analyze the differences in subsite specific expression of miR-21 in OSCC cases. It was significantly upregulated in the buccal mucosa (p=0.002), followed by GB sulcus (p=0.01) and Tongue (p=0.25). CONCLUSION: In conclusion, the study could identify the differential miR-21 expression at sub-sites, indicating that it may serve as a diagnostic marker with further elaboration on a larger sample size..

Advanced epithelial mapping for refractive surgery.

One of the leading challenges in refractive surgery today is the presence of underlying subclinical early-stage keratoconus (KC), which can lead to iatrogenic post laser in situ keratomileusis ectasia. Timely detection of this condition could aid the refractive surgeons in better decision-making. This includes being able to defer refractive surgery in subclinical cases as well as providing treatment for the same in the form of appropriate corneal collagen crosslinking treatments. Corneal topography is considered the gold standard for the diagnosis of corneal ectatic disorders. However, there is a likelihood that topographers are overlooking certain subclinical cases. The corneal epithelium is known to remodel, which may mask underlying stromal irregularities. Imaging and analyzing corneal epithelium and stroma independently will undoubtedly open newer avenues to supplement our understanding of postrefractive surgery outcomes and KC. This review encapsulates the various Optical coherence tomography-based epithelial mapping devices particularly RTVue (Optovue, Fremont, USA) and MS-39 (Costruzione Strumenti Oftalmici, Florence, Italy) in terms of their utility in these conditions. It will help guide the clinician on how including an epithelial mapping in clinical practice can aid in diagnosis, management, and interpretation of outcomes both for refractive surgery as well as KC.

Immunohistochemical study of α-smooth muscle actin expression in oral leukoplakia and oral squamous cell carcinoma.

CONTEXT: It is important to evaluate the role of stromal myofibroblasts (MFs) in carcinogenesis and also as a predictive marker for lymph node (LN) metastasis at the invasive front of oral squamous cell carcinoma (OSCC). AIMS: To demonstrate the expression of α-smooth muscle actin (α-SMA) by MFs in the tissues of oral leukoplakia (OL) with dysplasia and OSCC. To record and compare the distribution of MFs in OSCC with LN metastasis and without LN metastasis. SETTINGS AND DESIGN: Fifty paraffin-embedded tissue blocks with 10 cases of normal oral mucosa, 10 cases of OL with dysplasia and 30 diagnosed cases of OSCCs were studied. SUBJECTS AND METHODS: The samples were subjected to heat-induced antigen retrieval method followed by staining using primary mouse monoclonal antibodies against α-SMA and visualized using super sensitive polymer-HRP detection system. STATISTICAL ANALYSIS: Descriptive statistical analysis and ANOVA test were used for statistical analysis. RESULTS: There was no α-SMA expression in normal oral mucosa or in OL with dysplasia. All tissues of OSCC were positive for α-SMA expression. The difference in the expression between OL with dysplasia and OSCC was statistically significant (P < 0.05). The mean α-SMA count of OSCC with LN metastasis is significantly greater than in the OSCC without LN metastasis (P = 0.001). In OSCC without LN metastasis, focal and spindle patterns were predominant and in OSCC with LN metastasis network pattern was more. CONCLUSION: α-SMA expression by MFs in OSCCs indicates its role in tumor growth and invasion. The mean α-SMA count was found to correlate with tumor invasiveness and locoregional LN metastasis.

Odontogenic keratocyst arising in the maxillary sinus: A rare case report.

Odontogenic keratocyst is an aggressive cystic lesion and a common type of tooth derived cyst due to presence of odontogenic epithelial remnants in different regions of jaw. In majority of cases, it is located in mandibular posterior region. But it can also be found in the maxilla especially in the canine region. We present a rare case of OKC in maxillary sinus which associated with ectopic third molar. Also, it can be easily confused with other lesions of maxillary sinus like sinusitis or antral polyps, which usually resemble symptomatically. There can be malignant transformation of this benign condition towards squamous cell carcinoma or ameloblastoma. So an early and accurate diagnosis of odontogenic keratocyst is a challenge for pathologists.

Immunohistochemical study of alpha-smooth muscle actin in odontogenic cysts and tumors.

CONTEXT: Myofibroblasts (MFs) are fibroblasts with smooth muscle-like features characterized by the presence of a contractile apparatus. Alpha-smooth muscle actin (α-SMA) is the actin isoform that predominates within vascular smooth muscle cells and plays an important role in fibrogenesis. MFs are metabolically and morphologically distinctive fibroblasts expressing α-SMA, and their activation plays a key role in development of the fibrotic response. AIMS AND OBJECTIVES: The aim of this study is to demonstrate the frequency, distribution and expression of α-SMA-positive MFs in odontogenic keratocyst (OKC), dentigerous cyst (DC) and ameloblastoma and correlate it to their aggressive biological behavior. SETTINGS AND DESIGN: A retrospective study of 45 diagnosed cases, which includes 15 cases of OKC, 15 cases of DC and 15 cases of ameloblastoma, was undertaken to demonstrate expression of α-SMA retrieved from archives of our department. MATERIALS AND METHODS: α-SMA mouse anti-human antibody and horseradish peroxidase detection system were used in this study. STATISTICAL ANALYSIS: Descriptive statistical analysis and ANOVA test were used for statistical analysis. RESULTS: The difference in mean α-SMA count was found to be statistically significant between ameloblastoma and DC group (P < 0.001) as well as OKC and DC group (P < 0.001). No significant difference is observed between ameloblastoma and OKC group (P > 0.05). Results showed that mean number of stromal MFs in OKC and ameloblastoma were significantly higher than DC. CONCLUSION: The present study has shown that the mean number of MFs was higher in OKC and ameloblastoma, while the mean number of MFs in DC was quite low and significantly different from that of ameloblastoma and OKC.

Correlation of mucocutaneous manifestations of HIV-infected patients in an ART center with CD4 counts.

BACKGROUND: As the search for reliable clinical indicators for management of human immunodeficiency virus/AIDS continues, mucocutaneous manifestations of HIV are considered among key clinical indicators for prediction of underlying degree of immunosuppression, systemic opportunistic infections, and disease progression. OBJECTIVES: (1) To study the prevalence of mucocutaneous manifestations in HIV-seropositive patients attending the ART center of our hospital (2) To correlate mucocutaneous manifestations with CD4 cell counts. MATERIALS AND METHODS: A total of 200 HIV-seropositive patients of adult age group visiting our hospital were included in the study. Information on demographics such as age, sex, transmission route, socioeconomic status, educational status, CD4 counts, and mucocutaneous findings was collected through interview administered survey and case records followed by oral and cutaneous examination. RESULTS: Mean CD4 cell count of asymptomatic HIV/AIDS patients was 580.96 cells/mm3. In comparison with the CD4 cell count of asymptomatic HIV-positive patients, (mean 580.96 cells/mm3) CD4 cell count of HIV-positive patients with various mucocutaneous manifestations (mean 409.65 cells/mm3) was correlated using student t-test and was statistically significant (P = 0.017). CONCLUSION: This study revealed maximum mucocutaneous lesions in the CD4 count range of 200-500. Nail changes accounted for the most common cutaneous manifestation with 53%, and pigmentation accounted for the most common oral manifestation with 39%. Mucocutaneous manifestations can arouse one to suspect the diagnosis of HIV infection in an otherwise healthy unwary patient. They can serve as a dependable marker of HIV disease.

Mast cells and angiogenesis in malignant and premalignant oral lesions: An immunohistochemical study.

INTRODUCTION AND OBJECTIVES: Angiogenesis is a complex event facilitated by angiogenic factors released from neoplastic and host immune cells. Among host immune cells, mast cells (MCs) may have greater significance in tumor progression through angiogenesis. The objectives of the study were to evaluate and correlate mast cell density (MCD) and microvessel density (MVD) in normal gingival tissue, leukoplakia with and without dysplasia and oral squamous cell carcinoma (OSCC) cases. MATERIALS AND METHODS: Among eighty selected cases, twenty were of normal gingiva, twenty each of leukoplakia without and with dysplasia and twenty of OSCC. The slides were stained with CD34 and counterstained with 0.1% toluidine blue, followed by quantification of MCD and MVD per high-power field (×40) using Image-Pro Express software. STATISTICAL ANALYSIS: Chi-square test and correlation coefficient were used for statistical analysis. OBSERVATION AND RESULTS: A statistically significant difference in the values of MVD and MCD between normal gingival tissue, leukoplakia with and without dysplasia and OSCC (P = 0.000) was observed. MVD and MCD showed a positive correlation between the study groups. CONCLUSION: MVD and MCD increased significantly in cases of OSCC as compared to leukoplakia with and without dysplasia and normal gingival tissue. It was concluded that MCs may play a significant role in angiogenesis by releasing pro-angiogenic and angiogenic factors which may in turn favor the progression of premalignant lesion to a malignant one.

UDL and Intellectual Disability: What Do We Know and Where Do We Go?

As an instructional design framework that can be used to design curriculum for students with and without disabilities, Universal Design for Learning (UDL) has the potential to support meaningful inclusion of students with intellectual disability (ID) in general educational settings. This article presents an overview of the existing set of research studies on UDL application for students with ID in PreK-12 settings. The current body of research illustrates that UDL is being applied to instructional activities for students with ID to examine a variety of interventions (e.g., adapted stories for individual students, inclusive general education curriculum) and outcomes (e.g., interaction, perceptions, knowledge gains) in self-contained and general educational settings. It also identifies important questions for consideration in future research as the field seeks to determine how UDL guidelines can be applied to curriculum, used with evidence-based and effective practices, and used to support schoolwide initiatives inclusive of students with ID.

A quantitative analysis of mast cells in inflammatory periapical and gingival lesions.

AIM: The aim of the study was to quantify the presence of mast cells in various inflammatory lesions like periapical granuloma, periapical cyst, inflammatory gingival hyperplasia and pyogenic granuloma. Mast cell degranulation and association with lymphocytes were also recorded in an attempt to understand the role of mast cells in the pathogenesis of these inflammatory lesions. MATERIALS AND METHODS: The quantification of mast cells was done on toluidine blue stained sections of all the four groups of lesions, using the image analyzer software, Image-Pro-Express (Media Cybernetics, USA). RESULTS: An increased number of mast cells in various inflammatory lesions with a significant difference between the four groups were noted. Mast cell number tended to be greater in the lesions present in the anterior region of the mouth than in the posterior region of the oral cavity. The mean mast cell number decreased with the increasing age which was directly correlated with the age of the patients. Mast cell site, distribution, degranulation and its association with fibroblasts, lymphocytes and blood vessels were noted. CONCLUSION: The location of mast cells in different areas, their association with lymphocytes, fibroblasts, endothelial cells, and the phenomenon of degranulation helps to appreciate the release of various mediators and multiple interactions among these cells, leading to increased vascular permeability, angiogenic response, collagen synthesis, regulation of inflammation, bone resorption, and extracellular matrix destruction, thus contributing to the pathogenesis of these inflammatory lesions.

Immunohistochemical study of CD44s expression in oral squamous cell carcinoma-its correlation with prognostic parameters.

BACKGROUND AND OBJECTIVES: The study aims at the observation of the immunohistochemical expression of CD44s in Oral Squamous Cell Carcinoma (OSCC) and to correlate its expression with prognostic parameters. MATERIALS AND METHODS: A total of 30 cases of OSCC, - 10 cases of each well differentiated (WD SCC), moderately differentiated (MD SCC) and poorly differentiated squamous cell carcinomas (PD SCC) were included in the study. The sections were subjected to immunohistochemical study using CD44s antigen marker. The degree of intensity and distribution of CD44s immunostaining was assessed and correlated with prognostic markers such as tumor stage (tumor size), tumor grade (Broder's histological grading), tumor site, tumor thickness (histological depth of invasion) and nodal status. RESULTS: CD44s expression by tumor cells in OSCCs is statistically correlated with tumor grade i.e. Higher mean of CD44s immunoexpression was observed in WD SCC group (10.80 ± 3.97), followed by MD SCC group (5.90 ± 3.38) and PD SCC group showed least CD44s immunoexpression (3.70 ± 4.64). There was no statistical significance observed with respect to the other prognostic markers. CONCLUSION: Based on these observations it can be suggested that the decrease in expression of CD44s in OSCC cells may be due to the reduced cell-to-cell and cell-to-matrix adhesion, resulting in easy detachment from the rigid constitution. Low expression of CD44s in OSCC tissues may be an indicator of tumor invasion and high metastatic potential.

Expression of maspin in benign and malignant salivary gland tumors: an immunohistochemical study.

CONTEXT: Maspin is a novel serine protease inhibitor (serpin) with multifaceted tumor-suppressive activities. It was originally identified in normal human breast myoepithelial cells and shows variable expression in different types of cancer cells. Maspin displays anti-metastatic properties in mammary and prostate cancer. Its expression is maintained during ovarian, lung and pancreatic carcinogenesis, indicating that Maspin regulated metastatic potential is tissue specific. Thus, it is possible that Maspin participates in salivary gland tumor biology as well. In this study, expression pattern of maspin in benign and malignant salivary gland tumors is analyzed, to understand the biological behavior of salivary gland tumors with respect to maspin expression. AIMS AND OBJECTIVES: The aim of this study was to demonstrate, record, and correlate the expression pattern of maspin in benign and malignant salivary gland tumors. SETTINGS AND DESIGN: A retrospective study of maspin expression in 30 diagnosed cases of benign and malignant salivary gland tumors retrieved from archives of our department. MATERIALS AND METHODS: Anti-maspin antibody and horseradish peroxidase detection system. STATISTICAL ANALYSIS: Descriptive statistical analysis and Chi-square/Fisher Exact test. RESULTS: Intense expression with P < 0.001 is associated with benign tumors, nuclear staining with P < 0.001 is significantly associated with benign tumors and cytoplasmic staining with P = 0.020 is associated with malignant tumors. CONCLUSION: Intensity of expression is more in benign tumors when compared with malignant tumors. The benign tumors showed both nuclear and cytoplasmic expression. Some malignant tumors did express maspin, but mainly in the cytoplasm.

Herpes zoster: when do patients present and who gets antiviral treatment?

INTRODUCTION: Herpes zoster and its sequelae can have a serious impact on quality of life, particularly in the elderly. The duration and severity of herpes zoster symptoms can be reduced with antiviral treatment. Early treatment is most effective. AIM: To identify how soon after onset of herpes zoster symptoms adults presented to a suburban Dunedin general practice and to describe which patients received antiviral treatment. METHODS: Adult herpes zoster cases were identified from a large suburban general practice from 2004 to 2009. Duration of symptoms at presentation and antiviral prescription were identified from medical records and described by patient characteristics. RESULTS: We identified 278 incident cases. Approximately one-third presented within three days of symptoms, one-third after three days, and in one-third of cases the duration of symptoms was not documented. A higher percentage of patients with ophthalmic herpes zoster presented within three days (45%), while a lower percentage of men (24%) and patients from the lowest socioeconomic quintile (25%) presented within three days. Most incident cases received antiviral treatment. A higher percentage of patients with ophthalmic herpes zoster and patients who presented within three days of symptoms received antiviral treatment. Some patients who presented after seven days of symptoms also received treatment. Antiviral prescribing did not increase with patient age. DISCUSSION: Despite many adults with acute herpes zoster presenting after three days of symptoms, most received antiviral treatment. It is not known why many presented late. It is not known whether late treatment is effective.

Recurrent progressive anterior segment fibrosis syndrome following a descemet-stripping endothelial keratoplasty in an infant with congenital aniridia.

Progressive anterior segment fibrosis syndrome (ASFS), after intraocular surgery in older children (≥ 9 years) and adults with congenital aniridia, is described in the literature. In this report, we describe an unique case of ASFS in an infant with congenital aniridia following a combined trabeculotomy-ectomy and its recurrence after a descemet stripping endothelial keratoplasty. The ophthalmologists should be well aware of this entity and warn the parents about its possibilities. Use of immunomodulators or prolonged anti-inflammatory therapy may be considered to prevent its occurrence.

Benign fibrous histiocytoma of the tongue.

Benign fibrous histiocytoma (BFH) is a benign fibrohistiocytic neoplasm. It is documented to occur in all anatomic sites with a strong predilection for sun exposed skin surfaces. Intra oral occurrence of BFH comprises a lesser percentage of cases with tongue being the least reported site. We report a case of BFH of the tongue with an emphasis on its histogenesis and a review of the literature.

Ocular allergy and keratoconus.

Keratoconus is the most common corneal ectatic disorder, the cause of which is largely unknown. Many factors have been implicated, and the ocular allergy is being one of them. The commonly proposed pathogenesis includes the release of inflammatory mediators due to eye rubbing which may alter the corneal collagen and lead to corneal ectasias. The onset of keratoconus is often early in cases associated with allergy and routine corneal topography may detect subtle forms of keratoconus. These cases may require early keratoplasty and are at an increased risk of having acute corneal hydrops. Surgical outcomes are similar to primary keratoconus cases. However, post-operative epithelial breakdown may be a problem in these cases. Control of allergy and eye rubbing is the best measure to prevent corneal ectasias in cases of ocular allergy.