Infodemic in Public health a reemerging public health threat: a scoping review.

BACKGROUND: Infodemic is a neologism of 'information' and 'epidemic' coined in the year 2003. Evidence mapping is a technique to appraise the literature which enables the extent of research activity in a specific area to be discovered. The main objective of this evidence synthesis presents the outcomes of an evidence map that was directed to know the extent of Infodemics and its effects on public health.  Methods: The following methods were used to construct this evidence synthesis: Phase I. Construct a Broad Question Referring to the Field of Analysis. Phase II; Defining Key Variables to Be Mapped, identifying the characters of each variable and Outline Inclusion and Exclusion Criteria for the variables. Phase III: Literature search. Phase IV: Screening and Charting the Appropriate Evidence within the Synthesis.  Results:  Authors identified 55 records through database searching, after screening for duplicates, 53 records screened at title/abstract level of which, 16 records were removed because of lack of complete article or articles were not in English. 37 articles were eligible for full text screening, 37 full-text articles were than assessed for eligibility and only 22 articles were included as per inclusion criteria with an interrater Outcome Kappa value: 0.91. The strength of agreement was considered to be 'excellent'.  Conclusions: This synthesis focused majorly on the gaps in the research focused on infodemic. The two main gaps identified were lack of systematically conducted research and poor digital health literacy. As infodemic is a new phenomenon with respect to the COVID-19 pandemic it was an eye opener at different levels of public health, furthermore this evidence map points out areas for further research on the impact of infodemic.

Prognostic Nomogram for Lymph-Node Metastasis in Oral Squamous Cell Carcinoma (OSCC) Using Immunohistochemical Marker D2-40.

Introduction: Nomograms are proven in "individualized risk prediction" in sarcomas and breast and prostate cancers. Incorporating immunohistochemical markers and histopathological parameters can enhance accuracy of these graphical representations of statistical predictive models concerning metastasis. D2-40, a monoclonal antibody to podoplanin (regulator of motility expressed in malignant epithelial cells), dually predicts metastatic potential of tumour by estimating the motile tumour phenotype and by detecting lymphatic vessels/density, both essential to metastasis in OSCC. Thus, we propose a model that incorporates D2-40 immunostaining of individual tumour cells (ITC) too with other variables (seen in H+E staining) as a predictive nomogram. Methods: Sixty cases of OSCC were selected with equal number of cases (n=30) of pN0 and pN+ status. Bryne's grading of invasive front of tumour (ITF) was done on H+E-stained slides followed by D2-40 immunostaining for ITCs at ITF and lymphatic vessels. Multivariate regression analysis was used to generate the nomogram of LNM where the predictive contribution of each covariate, namely depth of invasion, D2-40-stained ITCs, gender, histological grade, and worst pattern of invasion (WPOI), was plotted on a scale of 1-100 points. Results: The nomogram showed that the strongest variable in OSCC was the WPOI in H+E-stained section followed by D2-40-positive ITCs and gender. Discussion: Our predictive nomogram for LNM in OSCC surprisingly showed that a tumour with lower score of WPOI (islands vs ITC) showed numerous D2-40-positive ITCs, drastically increasing the probability of metastasis. The concept of "individualized risk prediction" can be used to predict lymph node metastasis using a variety of histopathological criteria that can be visualized in routine and immunohistochemical staining in OSCC with the aid of a nomogram.

Novel behavioral model in evaluating initiation and sustenance of teeth brushing behavior among students pursuing health sciences: a cross-sectional study.

Background: Oral hygiene maintenance is a crucial and integral feature in determining the overall wellbeing of a person. It has been established that interventions for health promotion at the public health level derived from theoretical models based on social and behavioural sciences have a superior effectiveness as compared to the ones without a theoretical background. Hence a novel behavioral model known as the multi-theory model (MTM) was used to understand two important aspects of health behavior change: (i) Initiation and (ii) Sustenance in twice daily teeth brushing in a university setting with objectives to identify factors effecting MTM in initiation and sustenance of twice daily brushing behavior among students pursuing health sciences and correlating the MTM theory with socio-demographic and behavioral patterns. Methods: The study is an analytical cross-sectional study. Students pursuing Medicine and Dentistry in a University setting were included. A validated questionnaire was designed for this study. Questions were framed to evaluate the constructs of initiation and sustenance of MTM, personality, sleeping habits and demographic corelates of participants. Multiple means between the groups were compared using analysis of variance and a post hoc test. Correlation was established between different domains, the items were then entered for hierarchical multiple regression. Results: Of the 235 participants in the study, 229 completed the questionnaire. There was a significant association between brushing quartiles, professional streams (p<0.001) and academic performance (p<0.001). The hierarchical multiple regression revealed that at stage one, behavioral confidence contributed significantly to the regression model (F (1,227) = 33.227, p<0.001) and accounted for 12.4% of the variation in twice daily brushing. Conclusion: MTM is a good tool in predicting the initiation and sustenance of twice daily brushing behavior among young adults and can form a useful tool in assessing the patterns of brushing behavior in a population.

Performance of Dental Students in Understanding and Retention of Oral Pathology Concepts: A Comparative Analysis of Traditional versus Live-Field Teaching Methods.

Background: Understanding oral aspects of pathology by traditional techniques has always been a paradigm in the field of dental education. Traditional methods of teaching include interaction using black board, projectors, and alternate methods of teaching such as a student-centered approach where live-field demonstrations, audio visual aids, and student interaction are also gaining importance, ultimately promoting active education. The aim of the study was to compare live-field and static-field teaching methods in understanding and retention of the histopathological features in dental students. Methods: This was a cross-sectional analytical study, wherein a uniform cohort of III-year dental students was obtained by randomizing the study subjects. Practical classes were conducted using traditional black board/static pictures and dynamic live-field teaching comprising of microscope connected to an HD screen and projector demonstrating the preferred microscopic field. Alternately, the level of retention of knowledge was measured using customized topic-based tests. The comparison of average scores was done between live-field and static-field teaching groups using the paired t-test. Results: The test scores using the paired t-test were marginally elevated in the conventional mode of teaching; however, it varied with respect to precise topics taken using both the genres of teaching. Conclusion: A balance of both conventional and virtual teaching needs to be achieved to enhance the comprehension in student learning. Nevertheless, in the impending years, advanced research is entailed to see if the virtual mode of teaching could replace the conventional method for the advancement in the study prospects.

Morphometric anlaysis of mandibular coronoid, condyle and sigmoid shape using panoromic view for personal identification in south Indian population.

Objective: The shape of the condyle, coronoid, and the intervening sigmoid notch is unique due to attachments and direction of pull of temporalis muscle, different chewing habits, hormones, etc. So morphometric variation of these mandibular landmarks can be used in individual identification. Material And Methods: The study was carried out on 500 panoramic view images. Visual tracing assisted assessment of thousand sides (left and right) was done. Sexual dimorphism of left and right mandibular ramus parts (sigmoid notch bordered by coronoid and condylar process). The shape of coronoid process, condyle, and sigmoid notch were interpreted. Results: The most prevalent shape of sigmoid notch was wide variant (41.2%), condyle was convex type (50%) and coronoid was round (53.4%). Condyle and coronoid showed asymmetry between right and left with p-value 0.001 and 0.019, respectively. This study has illustrated that triangular-shaped coronoid was more in females (p-value 0.012). Conclusion: Sexual dimorphism is observed in the shape of the mandible due to masticatory activity at the point of insertion of temporalis muscle, biting force, hormones, and various genetic reasons. The results have exemplified that the morphometric variation of condyle, coronoid and sigmoid notch can be used as a tool for personal identification.

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.

Estimation of Age by Evaluating the Occlusal Tooth Wear in Molars: A Study on Dakshina Kannada Population.

PURPOSE: Assessment of teeth to estimate age in the living as well as the dead is well documented in the literature. Though applied in conjunction with other parameters in Gustafson's technique, attrition of teeth solely is an underexplored indicator for age estimation mainly in India. Most of the studies using attrition of teeth have been conducted in bioarchaeology, and in populations where studies are being conducted in forensic contexts, the results are debatable. Thus, the present study aimed to evaluate the accuracy of age estimation using the Average Stage of Attrition (ASA) method by Li and Ji in adults of the Dakshina Kannada region. MATERIALS AND METHODS: This cross-sectional study assessed the degree of attrition in both maxillary and mandibular first and second molars of 136 adults of Dakshina Kannada origin (age range: 20-70 years) according to the 10 stages given by Li and Ji to derive population-specific linear regression equations. RESULTS: Univariate analysis of prediction of age with attrition showed a significant association of attrition score with age, stratified by sex, arch as well as in total (p-value <0.001) with a standard error of estimate of 9.231 years. The estimated age was within ±5 years of the actual age in 44.2% of the females and 50.0% of the males. A comparative review of 23 studies done to estimate age from attrition score clinically is documented in the manuscript. CONCLUSION: The findings of this study suggest that evaluation of tooth wear by the Average Stage of Attrition (ASA) method can be used as a non-invasive means to aid in the determination of age in adults of Dakshina Kannada origin. Although the error increases with age, this method provides a measurable means of seriation into older and younger categories.

Development of Modified Dental Beliefs Scale Among an Adolescent Rural Population.

OBJECTIVE: Modified dental beliefs scale (MDBS), the shortened form of the R-DBS, was developed in a multicultural population. The factor structure of MDBS is not explored in an Indian context. The study explores psychometric properties and tests the fit of MDBS in a rural costal adolescent population in a vernacular language. MATERIALS AND METHODS: The cross-sectional analysis was carried out at two randomly selected rural Institutes in Costal Karnataka. Psychometric properties using a questionnaire were assessed. Validity and reliability were assessed by Cronbach's α, split-half reliability, and test-retest analysis. Statistical analysis: Factor analysis with varimax rotation was employed to add a level of statistical precision and assist in the development the instrument. Two models were developed and tested for goodness of fit, root mean square error of approximation, and comparative fit. RESULTS: The MDBS revealed a Cronbach's α value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.86 and 0.86, respectively. Test-retest reliability was found to be 0.74 (P < 0.01). Factor analysis revealed a five-factor solution explaining 67.8% of the variation in the scale. CFA revealed an appropriate goodness of fit for both models with better values for model two with chi-square value was statistically significant and the ratio value (χ2/df = 7.8). CONCLUSION: The results of the present study indicate that the MDBS is a reliable and valid tool for the present population subset, with good fit for the second model with two separate latent variables.

Tooth shade variation in Indian population: An objective guide to age estimation.

INTRODUCTION: The color of the teeth is affected by chronological age due to the variations of the hard and soft tissue structure of the teeth. There are very few studies have assessed the shade of the Enamel and correlated it with the age changes. Hence the study aimed to assess the enamel shade with the aging in the individual. MATERIALS AND METHODS: The central incisors of 388 individuals (5-78 years) were assessed for tooth color using a VITA 3D master shade guide and the Hue, Value and Chroma were noted. Mean grey values of the teeth were obtained by image manipulation using Image J software and normalized using the values obtained from the 18% contrast grey card. Chi square tests and linear regression analysis is used to find associations with age and tooth shade variations.Results: The teeth had higher score of Hue, Value and Chroma in older individuals. The tooth shade tended to shift towards redder hue with older age group. Simple linear regression analysis showed a significant correlation of age with normalized grey value in association with the shade parameters. (r = 0.717, SEE = 12.322 years)Conclusion: Tooth color changes with age and the mean age in grey values and shade guides can be a useful tool for age estimation.

Efficiency of Mobile Video Sharing Application (WhatsApp®) in Live Field Image Transmission for Telepathology.

Telepathology is in its nascent stages in India. Video calling applications in mobile phones can be efficiently used to transmit static and live field microscopic images hastening low cost telepathology. To evaluate the efficiency of WhatsApp® Video Calling for dynamic microscopy in distant diagnosis. Thirty haematoxylin and eosin stained slides of common pathologies were retrieved from the archives of Department of Oral Pathology and Microbiology, coded with relevant history and given to three untrained investigators. The investigators then connected a mobile phone with VOIP facility to a microscope using a custom adaptor. Dynamic fields were transferred to three independent pathologists via WhatsApp® video call. The pathologists attempted to diagnose the lesion based on the live field video over their display screen (phone). Audio quality was found to be better than that of video. In 70% of the cases, pathologists could render a diagnosis (13% gave a confirmed diagnosis, 57.7% gave a probable diagnosis). The average time taken for connecting the adaptor, connecting the call to the pathologist and then receiving the diagnosis was 9:30 min. In addition, proper history taking and staining of the tissue slides were critical to arrive at the diagnosis. WhatsApp® free VOIP facility helped untrained investigators to send the live-field pathologic fields to a specialist rendering histopathological diagnosis. The factors affecting the diagnosis included network stability, clarity of images transmitted, staining quality and contrast of nuclear details of the stain. The history, clinico-pathologic correlation, transmission of static images, training of the person transmitting the images plays a vital role in rendering accurate diagnosis. Telepathology over WhatsApp® video calling could be used as an efficient screening tool to identify suspicious lesions and follow-up critical cases.

Expression of Laminin in Oral Squamous Cell Carcinomas

Background and objectives: Laminin is a significant basement membrane (BM) glycoprotein, the expression of which reflects BM integrity more precisely than do other ECM proteins. The present study aimed to evaluate laminin expression in oral squamous cell carcinomas OSCC and to determine any associations with clinico-pathological parameters (surgical margin status, lymph node involvement, survival and recurrence). Methods: Laminin expression was evaluated in 31 cases of biopsy-proven OSCC by immunohistochemical staining and its association with prognosticators and the Brynes grading system was determined by appropriate statistical analysis. Results: We observed a significant increase in linear staining pattern (p<0.001) at the tumour-host interface in well-differentiated OSCC cases, in contrast to poorly differentiated lesions which exhibited intense cytoplasmic expression within tumour cells. Higher cytoplasmic laminin expression was seen in 33.3% of cases with involved surgical margins and 69.2% of cases with lymph node metastasis (along with weak/absent staining of laminin around the tumour-host interface ­ Basement membrane around tumour islands). Similarly, in 60% of the cases who died and in 81.8% of cases with tumour recurrence, moderately intense cytoplasmic laminin expression was seen within tumour cells. On comparing variables of the Brynes grading system, significant cytoplasmic expression of laminin was linked with mild inflammation (p<0.0016) and increased mitotic activity (p<0.008). Conclusion: Based on these observations, immunohistochemical expression of laminin might be useful to evaluate histological differentiation and aggressiveness of OSCCs.

Dysgenetic Polycystic Disease of Minor Salivary Gland: A Rare Case Report and Review of the Literature.

Polycystic (dysgenetic) disease of the salivary glands is a rare entity that has only recently been described in the literature. The disease is more commonly seen in females and majority of the cases have presented as bilateral parotid gland swellings. This case presenting in a 21-year-old male is the first of this unusual entity involving solely the minor salivary gland on the lower lip. This case report highlights the importance for the clinician to be aware of this differential diagnosis, when treating an innocuous lesion like a mucocele.

Tumour-Associated Tissue Eosinophilia in Oral Squamous Cell Carcinoma- A Boon or a Bane?

INTRODUCTION: The infiltration of tumour stroma by eosinophils, Tumour-Associated Tissue Eosinophilia (TATE) is known to modulate the evolution of Oral Squamous Cell Carcinoma (OSCC). Identification of eosinophils in the inflammatory stroma has been proven to be an important factor in prognostication of malignant tumours including cancers of mouth, oesophagus, larynx, pharynx, breast, lung, intestine and genitourinary tract. AIM: Our study aimed to assess the role of TATE as a prognosticator in OSCC as visualized by Haematoxylin and Eosin (H&E) and congo red staining. MATERIALS AND METHODS: Thirty histologically-proven cases of OSCC were retrieved from the archives of Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal University, Karnataka, India. Two serial sections of 4µm thickness were made and subjected to routine staining with H&E and modified congo red staining, where eosinophil granules stained red and nuclei stained blue. In 40x magnification, 10 HPF at invasive tumour front were assessed for counting eosinophils by placing a 49 square grid (measuring 0.0289 sq mm). STATISTICAL ANALYSIS: The TATE was compared with the prognosticators using Mann-Whitney U-test. The grades of carcinoma were correlated with TATE using Kruskal-Wallis test followed by Post-hoc Bonferronis correction. Agreement of the number of eosinophils counted in the two staining techniques (H&E and Congo red) in OSCC was achieved using interclass correlation coefficient, and Friedman's test. A value of p< 0.05 was considered statistically significant. RESULTS: Our results showed that tissue eosinophil counts were higher in well-differentiated cases of OSCC, cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. H&E stain showed significantly better visualization of eosinophils resulting in higher eosinophil counts than when seen with Congo red (p=0.008). CONCLUSION: Thus, TATE can be used as a surrogate marker in prediction of survival and recurrence in OSCC. H&E proved to be a better stain for evaluation of eosinophils.