Evaluation of salivary tumor necrosis factor α as a diagnostic biomarker in oral submucosal fibrosis and squamous cell carcinoma of the oral cavity and oropharynx: a cross sectional observational study.

Introduction: Tumor necrosis factor α (TNF-α) is known to be associated with chronic inflammation, and its expression has been shown to increase in advanced cancers. Chronic inflammation is a characteristic feature of oral submucous fibrosis (OSMF), which is a potentially malignant disorder (PMD). Squamous cell carcinoma (SCC) is associated with considerable mortality and morbidity and an early detection or monitoring would greatly help in achieving an effective cure. TNF-α was thus evaluated for use as a biomarker in the present study according to the stage of OSMF and histological grade of SCC in the oral cavity and oropharynx. Methods: This study included 45 patients divided into 3 groups-OSMF group, SCC group and control group-each comprising 15 participants. Saliva samples were collected from each patient, and salivary TNF-α levels were estimated using an ELISA kit. Results: Statistical analysis revealed no significant differences in TNF-α levels among the OSMF, SCC and control groups; however, there was an increase in the salivary TNF-α level in patients with stage 3 disease according to the clinical stage of OSMF, for which the p value was 0.027. Discussion: An increase in the TNF-α concentration with increasing clinical stage suggested a role for TNF-α in the spread of OSMF involvement in anatomical structures of the oral cavity and oropharynx. No significant difference in salivary TNF-α levels was noted among the OSMF, SCC and control groups. Conclusion: The study showed a positive correlation of TNF-α with increasing stages of OSMF but was not a reliable biomarker in the categorization of the same.

Accessory lingual mental foramen: A case report of a rare anatomic variation.

INTRODUCTION: The mandibular nerve and the mental foramen have occasionally shown variations in its anatomy. This report aims to present a case of lingual mental foramen recognised on three-dimensional cone beam computed tomographic imaging (CBCT). CASE REPORT: Routine Orthopantomogram (OPG) and CBCT images were evaluated to assess the status of impact third molars in a 31-year-old female who had visited the dental clinics in our institution. The OPG image failed to reveal any anatomic variation in the position of the mental foramen. On tracing the course of the mandibular canal in CBCT images, two foramina were traced at the region of premolar. One opened towards the buccal cortical plate at the normal position of the mental foramen and an accessory lingual mental foramen had an opening on the lingual cortical bone at the same level as the mental foramen. CONCLUSION: Understanding variations of the mental foramen is extremely essential in dentistry to carry out successful anaesthetic or surgical interventions and to avoid complications such as nerve damage or excessive bleeding.

Prevalence of Incidental Maxillary Sinus Anomalies on CBCT Scans: A Radiographic Study.

CBCT significantly impacts dental procedures and has brought significant reforms to our approach to diagnosis and treatment planning despite its limitations in differentiating soft tissues. It is an excellent imaging modality and quickly identifies sinus opacification and provides valuable insight into paranasal sinus pathologies, with considerably lower radiation exposure. The present study aimed to investigate the occurrence of maxillary sinus abnormalities in CBCT scans, identify the frequency, type, and location of these findings, and find the correlation between the distance of periapical lesions and radiographic changes in the maxillary sinus. Two examiners independently evaluated 117 patients to diagnose and classify the cases into different abnormality subtypes. The periapical lesions most closely related to the sinus were recorded. The diameters of the left and right maxillary sinus ostium and the distance of the ostium's lower border to the sinus's osseous floor were recorded. The findings were correlated with the age and gender of these patients. The present study reveals that sixty-one patients were diagnosed with mucosal thickening (52.1%). The sinus wall most affected by mucosal thickening was the maxillary sinus floor, followed by the medial and lateral walls. Of 19 patients with periapical lesions, 15 had maxillary sinus mucosal thickening, which is statistically significant (p = 0.004). The high occurrence of abnormalities in the maxillary sinus emphasizes the importance for the radiologist to comprehensively interpret the whole volume acquired in CBCT images, including the entire sinus. Incidental findings may be considered in the individual clinical context of signs and symptoms, reducing the risk of overestimating the real impact of radiographic findings.

Third molar maturity index as an efficient tool for prediction of age in a sample Indian population - A retrospective study.

Introduction: The age of 18 years is an important milestone for legal matters, and developmental parameters of teeth are often used for estimation of this age. The aim of this study is to assess the efficiency of third molar maturity index (I3M) in establishing age of 18 years in Dakshina Kannada population. Methods: A total of 700 orthopantomograms were retrieved from the archives of the radiology department of Manipal College of Dental Sciences, Mangalore. The length and the width of the open apex of the mandibular left third molar was assessed using Image J software and the Third molar maturity Index (I3M) was calculated and correlated with the age of the individual. Results: Receiver operating characteristic (ROC) curve analysis showed the Area under curve of 0.94 and 0.96 in females and males, respectively, for prediction of age of 18 years. The cut-off of 0.08 predicted the 18-year cut-off with 97% specificity and 90.2% negative predictive value. The percentage of the accuracy was 80.23% if the I3M was <0.08. Conclusion: The efficiency of the cut-off of 0.08 of I3M has been tested in various population including Kosovar, Peruvian, South Indian, Libyan, Montenegro, Croatian, African (Botswana), Albanian, and Serbian. Our study also shows the efficiency of the same in South Indian Dakshina Kannada population.

Evaluation of Malnutrition and Quality of Life in Patients Treated for Oral and Oropharyngeal Cancer.

BACKGROUND: Oral and oropharyngeal cancer is a debilitating disease with high morbidity and mortality. Depending on the site and extent of the involvement of the cancer and the type of treatment modality, these patients can develop pain, trismus, xerostomia, dysphagia, and taste disturbances, compromising them socially and nutritionally. The aim of the study was to evaluate malnutrition and quality of life in patients treated for oral and oropharyngeal cancer. Methodology. A cross-sectional study was conducted which included 97 patients treated for oral and oropharyngeal cancer. The quality of life of the selected patients was assessed by using a validated European Organization for the Research and Treatment of Cancer's Quality of Life Questionnaire, Head and Neck and Mandibular Function Impairment Questionnaire. Pre- and posttreatment weight of the patients were assessed, and weight loss of ≥10% of pretreatment weight was considered as malnutrition. The chi-square test was used to correlate the symptoms with the quality of life. A paired t test was used to assess the differences in weight before and after treatment, and a p value of <0.005 was considered as significant. RESULTS: The most commonly reported symptoms were xerostomia (93.81%), pain (81.44%), and dysphagia (76.3%). A total of 40.2% of the individuals in the study had malnutrition. Malnutrition was comparatively lower in the group who had nutritional supplements. CONCLUSION: The quality of life in patients treated for oral and oropharyngeal cancer deteriorates immediately after the treatment; however, it significantly improves over time.

Morphological Assessment of TMJ Spaces, Mandibular Condyle, and Glenoid Fossa Using Cone Beam Computed Tomography (CBCT): A Retrospective Analysis.

Background The temporomandibular joint (TMJ) is included in the category of ginglymoarthrodial synovial joints. The mandibular condyle plays a vital part in the development of the craniofacial complex. Hence, the evaluation and assessment of the condylar volume and its morphology are of utmost importance. Aim The aim of this research was to use cone beam computed tomography (CBCT) imaging modality to evaluate the morphology of the mandibular condyle and glenoid fossa in a selected population and document any morphometric changes. Setting and Design It is an observational study. Materials and Methods A retrospective CBCT analysis was performed on 119 patients. The length, width, height, linear measurements of the joint spaces (anterior, posterior, and superior), volume of the condyle, and roof of glenoid fossa thickness were evaluated on both the left and right sides in both males and females. Results The height, width, and length of mandibular condyle were significantly increased in males on both sides. Except for the left anterior space, all other spaces were significantly larger in males. Overall, the volume of the condyles in males was significantly increased on both sides. Conclusion CBCT can be a valuable diagnostic aid in the evaluation of various dimensions, joint spaces, and condylar volume in different planes and thus, can be a useful predictor in the assessment of treatment outcomes of disorders affecting the TMJ.

Polymorphous Adenocarcinoma: A Rare Case Report with Unique Radiographic Appearance on CBCT.

BACKGROUND: Polymorphous low-grade adenocarcinoma (PLGA) is a slow growing malignant tumor of minor salivary glands and is generally of indolent nature. However, according to the most recent WHO Classification of Salivary Gland Tumors (2017), the cancer is classified as Polymorphous AdenoCarcinoma (PAC). PAC presents as a less aggressive tumor, though it could on rare occasions demonstrate distant metastasis. Case Presentation. A 47-year-old man who was referred by a private practitioner for a CBCT scan in reference to a proliferative soft-tissue growth in the hard palate. The growth was mild and tender and there was Grade III mobility in relation to all the maxillary teeth. Panoramic radiograph taken previously had revealed evidence of alveolar bone loss in relation to the maxillary teeth and was inconclusive of any other findings. The CBCT scan revealed evidence of moth-eaten appearance of maxilla with destruction of medial and lateral walls and floor of maxillary sinus. There was also evidence of involvement of right eustachian tube, ethmoidal wall, and nasopalatine canal. An intraosseous malignancy of the palate was suspected, and a total maxillectomy was performed. The tissue sample was sent for histopathological assessment wherein changes diagnostic for polymorphous low-grade adenocarcinoma of the palate were observed. CONCLUSION: PAC is a distinct, yet commonly occurring, minor salivary gland tumor with varied clinical and histologic appearance. This case report highlights the importance of CBCT in diagnosing the intraosseous involvement of such tumors which can help shed some light in enhancing our knowledge about the minor salivary gland malignancies like PAC.

CBCT analysis of pharyngeal airway volume and comparison of airway volume among patients with skeletal Class I, Class II, and Class III malocclusion: A retrospective study.

Objective: To study the influence of skeletal malocclusion on the oropharyngeal airway volume and the difference in the airway volume among gender and the different types of skeletal malocclusion.Methods: A retrospective analysis of 180 full-field of view (FOV) CBCT scans (55 in Class 1, 55 in Class II, and 70 in Class III) were assessed to measure the oropharyngeal airway volume, ANB angle, SNB angle, and Wits appraisal. The values were compared among different skeletal malocclusions and were correlated to gender.Result: There was a significant result in terms of oropharyngeal airway volume among different types of skeletal malocclusion and ANB angle, SNB angle, and Wits appraisal among males and females.Conclusion: CBCT is a cheaper, more convenient option than polysomnography (PSG) when assessing airways, and thus, a maxillofacial radiologist is importantly placed in the assessment of the retropalatal and retroglossal volume of the oropharyngeal airway.

Influence of Psychosocial Factors and Parafunctional Habits in Temporomandibular Disorders: A Cross-Sectional Study.

INTRODUCTION: Temporomandibular disorders (TMDs) are abnormalities affecting the temporomandibular joint, jaw muscles, or both. An intrinsic relationship reportedly exists between TMDs and psychosocial factors, including stress. Parafunctional habits such as bruxism and clenching are also known to be responsible for TMDs. OBJECTIVE: To determine the association of anxiety, depression, and bruxism with TMD symptoms and their relationship with age and sex. METHODS: Patients included in the study reported, as their chief concern, pain lasting for more than a week in the temporomandibular joint area and/or masticatory muscles. The patients were divided into age groups as follows: Younger than 20 years, 21 to 30 years, 31 to 40 years, 41 to 50 years, 51 to 60 years, and above 60 years. Patients were examined clinically and were asked to complete an anamnestic questionnaire (modified version of Helkimo Anamnestic Index) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Seventy-five patients (55 women, 20 men) were included in the study. The prevalence of TMDs was higher in female patients, of whom 33 (60%) had moderate to severe TMDs. Of the 20 male patients, 12 (60%) had signs and symptoms of moderate TMDs. Anxiety and depression scores were higher in female patients. No significant correlation was found between degree of malocclusion and TMDs. DISCUSSION: We found correlations between the degree of TMD with age, sex, parafunctional habits, and psychosocial factors. Symptoms of TMD seemed to increase in patients with parafunctional habits, from younger to older age groups, and with increased anxiety and depression scores. CONCLUSION: The degree of TMDs is higher in women, and TMDs are associated with higher anxiety and depression scores. Correlation between these factors paves the way for preventive actions aimed at those with moderate and severe signs of TMDs.

A Prospective Study of the Clinical and Demographic Profile of Type 2 Diabetes Mellitus Patients Receiving Antidiabetic Drug Combinations.

BACKGROUND: The specific treatment recommendations for type 2 diabetes mellitus (T2DM) differ based on a particular guideline. The goal of pharmacotherapy is to achieve the target HbA1c and fasting and postprandial blood glucose levels to avoid disease complications. OBJECTIVE: To evaluate the profile of T2DM patients on different antidiabetic treatment regimens and the factors leading to dose escalation in these patients. METHODS: A prospective descriptive study was conducted at Kasturba Medical College Hospital, Mangalore, a tertiary care teaching hospital, over a period of one year. The study population comprised of patients with T2DM for ≥5 years. The demographic and clinical data were collected during the baseline and follow-up visits. RESULTS: Of the 119 patients studied, 59.7% were males; 32.8% were ≥65 years of age. A significant decrease in the fasting blood glucose (FBG) on follow-up was seen (p = 0.028) in patients on sulfonylurea and metformin combination. A significant decrease in the glycated haemoglobin (HbA1c) was seen in patients on sulfonylurea with metformin and pioglitazone (p = 0.011); sulfonylurea with metformin, pioglitazone, and sitagliptin (p = 0.026); and metformin with insulin (p = 0.001). Patients who received dose escalation had a longer duration of the disease (p = 0.042), higher FBG (p = 0.039) and HbA1c (p = 0.05). CONCLUSION: A combination of metformin with sulfonylurea was the preferred first-line treatment; insulin was added when HbA1c was >9. Patients who received dose escalation had a longer duration of the disease and higher FBG and HbA1c.

Comparison of Transcutaneous Electric Nerve Stimulation (TENS) and Microcurrent Nerve Stimulation (MENS) in the Management of Masticatory Muscle Pain: A Comparative Study.

Introduction: Temporomandibular disorders (TMDs) are a heterogeneous group of pathologies affecting the temporomandibular joint (TMJ), the jaw muscles, or both. Epidemiological studies of TMD reveal a prevalence of 82% in the general population with 48% of them presenting with clinical features of muscle tenderness and difficulty in mouth opening. TMD are considered to be the most common orofacial pain conditions of nondental origin. Methods: The patients with TMD were randomly divided into two groups, A and B, based on their VAS scale. Group A consists of two subgroups 1 and 2 each consisting of 15 patients. Group B consists of two subgroups 3 and 4 consisting of 15 patients. Patients in Group A were given TENS for twenty minutes, and the frequency is adjusted as follows: (i) subgroup 1: TENS frequency at a range of 0-5 (VAS measuring 1-5) and (ii) subgroup 2: TENS frequency at a range of 5 and above (VAS measuring 6-10). Patients in Group B were given MENS for twenty minutes, and the frequency adjusted as follows: (i) subgroup 3: MENS frequency at range of 0-5 (VAS measuring 1-5) and (ii) subgroup 4: MENS frequency at a range of 5 and above (VAS measuring 6-10). Each patient was recalled for five consecutive days for the treatment, and the same intensity and frequency were maintained throughout the treatment period. Results: The improvement in VAS is seen to be highly significant statistically in MENS subgroup 4 (moderate-to-severe pain). Subgroups 1 and 3 had improvement in VAS which was comparable in both TENS and MENS groups. Conclusion: In the present study, it was found that TENS and MENS are equally effective in improving the functional mouth opening. MENS showed better and immediate effect in relief of pain. Microcurrent also has the advantage of being subthreshold, and hence the side effects such as tingling sensation and paresthesia seen to occur in some patients following TENS are absent. TENS and MENS can be considered as the first line of treatment in patients with acute and chronic masticatory muscle pain and also as an effective treatment option in cases of functional mouth opening.

Challenges in Early Diagnosis of Oral Cancer: Cases Series.

Oral cancer has an overall survival rate of only 50%. This prognosis is significantly improved when this disease is diagnosed and treated in its early stages. Oral cancer is usually associated with classical clinical features associated with malignancy resulting in accurate diagnosis. However, certain cases of oral cancer, especially in its early stages, can be clinically deceptive and can be misdiagnosed. There is a recent trend of changing demographics and etiology associated with oral cancer adding to the diagnostic challenges faced by the clinician. The awareness of these changing trends is needed to aid in early diagnosis of oral cancer. In this case series, we have presented three cases of patients with challenging aspects.

Incidence of Opportunistic Infections among HIV-Positive Adults on Highly Active Antiretroviral Therapy in a Teaching Hospital, India: Prospective Study.

Oral manifestations in HIV infections are numerous and some of these are acknowledged as being of great importance in the early diagnosis of the disease. Many HIV-associated oral infections occur early in HIV disease, not infrequently as the presenting sign or symptom. Thus, early detection of the associated oral opportunistic infections should, in many cases, result in earlier diagnosis of HIV infection. Cytology, a simple, painless, and inexpensive method, has become a preferred method and was used in our study for early diagnosis of certain lesions. To determine the effect of highly active antiretroviral therapy on incidence rate of opportunistic infections among HIV-positive adults in a teaching hospital in India, a prospective study was conducted and the required sample size was 40. Study participants were selected randomly from the outpatient department of an HIV clinic who were currently on for antiretroviral therapy (ART). Data on age, gender, form of contagion, antiretroviral therapy at the time of review, number of CD4 lymphocytes per milliliter, and viral load were collected. Oral cytologic investigation was carried out and then stained for histopathological examination. A total of 40 individuals were examined and the incidence of opportunistic infections was 66.7% in individuals with CD4 counts less than 200, 55.6% in individuals with CD4 counts of 200 to 499, and 40.0% in individuals with CD4 counts more than 500. The incidence of opportunistic infection was higher in individuals with low CD4 counts in spite of being on ART.

Detection of human papilloma virus in potentially malignant and malignant lesions of the oral cavity and a study of associated risk factors.

BACKGROUND: Squamous cell carcinoma of the head and neck is the 6th most frequently occurring cancer worldwide, with over 400,000 cases projected annually. Multiple factors such as tobacco, alcohol, irradiation, virus, and chronic irritants are involved in the development of oral squamous cell carcinomas (OSCCs). The most important risk factors are chronic exposure to tobacco and alcohol. Although the evidence that implicates virus is increasing, particularly (human papillomavirus [HPV]), in the carcinogenesis process, the role of virus is not well established. AIM AND OBJECTIVE: This study is designed to assess the presence of HPV in potentially malignant and malignant lesions of the oral cavity as well as to correlate the presence of HPV with addictive habits and histopathological grading of the disease. MATERIALS AND METHODS: Biopsy samples of OSCC and potentially malignant lesions were obtained and 3, 5 µm thickness sections were cut using a microtome. The sections were collected using a sterile brush and transferred to an Eppendorf tube. DNA extraction and polymerase chain reaction for the detection of HPV were done. RESULTS AND CONCLUSION: The association between histopathological grading and presence of HPV was assessed using Chi-square test and the values thus obtained were found to be statistically significant. HPV was more predominantly seen in well-differentiated carcinomas and moderately differentiated carcinomas as compared to poorly differentiated carcinomas.

Oral Cytology for HIV: A New Diagnostic Tool?

AIM: To asses morphological and morphometrical alterations of oral squamous epithelial cells in HIV infected individuals, and determine its diagnostic significance for HIV infection. MATERIALS AND METHODS: Informed Consent was obtained from all study subjects. 40 adult HIV infected patients (experimental group) and 40 adult non-infected volunteers (control group) participated. Age, occupation, and relevant medical history were recorded. The following laboratory tests reports were recorded: complete blood cell counts, blood glucose levels, serum iron and erythrocyte sedimentation rate. Oral smears were collected from normal appearing tongue and buccal mucosa of the individuals by exfoliative cytology. The cells were morphologically analysed and the nuclear area (NA), the cytoplasmic area (CA) and the nucleus-to-cytoplasm area ratio (NA/CA) were calculated. Cell yield, cell cohesion, presence/absence of inflammatory cells and candida were observed. RESULTS: The cytological smears of HIV patients showed abundant cell yield and the epithelial cells were found to be in close cohesive clusters and both findings were found to be statistically significant. Nuclear cytoplasmic ratio was seen to be increased in 93.8% of HIV positive patientsand Mild to moderate pleomorphism was observed in 17.9% of HIV positive patients. HIV positive patients had a diminished inflammatory response and this was found to be statistically significant. CONCLUSION: Statistically significant deviations from normal oral epithelium were found in the study conducted. With further research, oral exfoliative cytology may form a new, painless, inexpensive diagnostic method for HIV infections.

Epidermoid cyst of the floor of the mouth.

Dermoid cysts are malformations that are rarely seen in the oral cavity. An intraoral dermoid cyst grows slowly, but may enlarge and interfere with deglutition and speech, or can pose a critical risk to the airway and therefore require immediate surgical intervention. Dermoid cysts may develop above or below the mylohyoid muscle, causing a submental or submandibular swelling. Surgical excision is the treatment of choice and recurrence is rare. An intraoral approach for the treatment of large lesions presenting above the mylohyoid muscle provides good cosmetic and functional results. We report a case of a 26-year-old female who developed an epidermoid cyst presenting as a large sublingual swelling causing speech and swallowing difficulties. The lesion was surgically excised using an intraoral approach. Microscopic examination revealed a dermoid cyst of the epidermoid type. This case shows that dermoid cysts may be successfully diagnosed and managed using a series of simple yet effective clinical procedure.

Assessment of learning styles of undergraduate medical students using the VARK questionnaire and the influence of sex and academic performance.

While there are several tools to study learning styles of students, the visual-aural-read/write-kinesthetic (VARK) questionnaire is a simple, freely available, easy to administer tool that encourages students to describe their behavior in a manner they can identify with and accept. The aim is to understand the preferred sensory modality (or modalities) of students for learning. Teachers can use this knowledge to facilitate student learning. Moreover, students themselves can use this knowledge to change their learning habits. Five hundred undergraduate students belonging to two consecutive batches in their second year of undergraduate medical training were invited to participate in the exercise. Consenting students (415 students, 83%) were administered a printed form of version 7.0 of the VARK questionnaire. Besides the questionnaire, we also collected demographic data, academic performance data (marks obtained in 10th and 12th grades and last university examination), and self-perceived learning style preferences. The majority of students in our study had multiple learning preferences (68.7%). The predominant sensory modality of learning was aural (45.5%) and kinesthetic (33.1%). The learning style preference was not influenced by either sex or previous academic performance. Although we use a combination of teaching methods, there has not been an active effort to determine whether these adequately address the different types of learners. We hope these data will help us better our course contents and make learning a more fruitful experience.

Assessment of quality of life in patients with chronic oral mucosal diseases: a questionnaire-based study.

CONTEXT: A validated discipline-specific questionnaire has been developed recently to assess the quality of life (QOL) in patients with chronic oral mucosal diseases. OBJECTIVE: Use the Chronic Oral Mucosal Diseases Questionnaire for evaluating a diverse group of patients with chronic oral mucosal disease after therapy. DESIGN: Prospective convenience sample. MAIN OUTCOME MEASURE: Quality of life. METHODS: Seventy patients seen in the Department of Oral Medicine and Radiology with oral lichen planus, recurrent aphthous ulcers, pemphigus, and other chronic oral mucosal diseases were included in the study. Patients completed the questionnaire after undergoing treatment of their oral mucosal disease to assess their QOL. RESULTS: Patients older than age 35 years reported significantly lower QOL (p = 0.015) in the domain of social and emotional status. Significant age-related differences in QOL were not observed in other domains. Older individuals also reported a significantly lower overall QOL. Men reported significantly better oral health-related QOL than women did in pain and functional limitation: 16.14 ± 8.94 vs 21.44 ± 7.696, respectively (p = 0.010). Significant differences were not observed between sexes for other domains. Significant differences were observed between the disease groups only for recurrent aphthous ulcers and pemphigus (p = 0.005). Patients with pemphigus had the worst overall QOL (73.6 ± 5.6). CONCLUSION: Even after treatment, chronic oral mucosal diseases negatively affect patients' QOL. Use of the Chronic Oral Mucosal Diseases Questionnaire may allow physicians to more effectively care for their patients with these diseases.

The perceptual preferences in learning among dental students in clinical subjects.

INTRODUCTION: VARK is a questionnaire which was developed by Neil Fleming (www.vark.learn.com), who was a teacher and an educator in New Zealand, with respect to the perceptual preferences in learning. V stands for Visual- the students learn best from pictures, graphs and diagrams. A stand for Aural - the students learn best from spoken words, lectures and discussions. R stands for Reading - the students learn best from reading and writing texts. K stands for Kinesthetic - the students learn best when they move their bodies and manipulate things with their own hands. AIM: The aim of the recent study was to investigate the learning styles among the dental students in our clinical set up. METHOD: The VARK-questionnaire contains 13 multiple-choice- questions with four possibilities to select an answer. Each possibility represents one of the four modes of perception. But, one can select more than one answer for each question, which is necessary for the identification of the poly modal modes of perception and learning. This is also a psychometric problem when an attempt is being made to state a measure of the reliability of the questionnaire. The VARK-questionnaire was distributed among 100 students and we received filled forms from only 70 students. This sample size represented a 70% response rate from the students in the class and it was markedly above the level which was required to make conclusions about the student preferences for receiving and processing information. The students spent about 10 minutes in an ordinary lesson to fill in the questionnaire. The students' register numbers and names were used in the study and no blinding was practised. We analyzed their learning styles with their performances in the university exams. STUDY DESIGN: This was a questionnaire based clinical study. RESULTS: The responses from the students in our University where classified into the multi-modal (VARK), tri-modal (VRK, VAK, VAR, ARK), bi-modal (VR, VA, VK, RK) and the uni-modal (V, A, R.K) categories. The results showed that the subjects had a higher preference for multimodal learning. CONCLUSION: With our preliminary data, we conclude that the students in our clinical set up preferred a multimodal and a more of kinesthetic method of learning. To meet their needs, variations in the teaching, learning and the examination must be implemented. If not, the students with a high kinesthetic preference for perception and learning may be at the losing end.

Salivary protein markers: a noninvasive protein profile-based method for the early diagnosis of oral premalignancy and malignancy.

An ultra-sensitive hyphenated technique, high-performance liquid chromatography-laser-induced fluorescence detection protein profiling of saliva, is evaluated for early detection and diagnosis of oral premalignancy and malignancy. Calibration sets of protein profiles of unstimulated whole saliva are collected from clinically/pathologically normal, premalignant, and malignant subjects and used as standards. Three parameters-scores of factors, sum of squared residuals, and Mahalanobis distance-derived from principal component analysis of protein profiles of the standard calibration sets, and blind samples are used for "match/no-match" diagnosis of the blind samples. Analyses of the results show that the method is capable of differentiating normal, premalignant, and malignant conditions with the sensitivity and specificity of 79% and 78%, respectively. The technique provides a fast, highly objective (free from personal judgment and statistically defined), and noninvasive diagnostic method for screening and early detection of oral cancer.