Revisiting the cortisol reference ranges in humans: the role of demographics.

The current study explores the effect of demographics on serum cortisol expression in a study group of 52 individuals to improve the current serum reference ranges to produce personalized expression profiles consequently increasing clinical confidence in the diagnosis. The serum cortisol concentration was inspected against demographical data like age, sex, and body mass index and showed an association with age and sex. The serum cortisol values also indicated a positive association with chronic illnesses however this finding requires a more focused study for establishment. Additionally, saliva samples are also collected from the same study group at the same time through drool and an absorbent sponge and correlated with serum values to draw an alternative route of serological testing. Salivary cortisol from drool showed a linear correlation with Pearson's correlation coefficients of 0.71 and 0.72 with serum cortisol and with saliva samples collected using a porous sponge respectively. Overall, the study shows the role of demographics in shaping the reference ranges for cortisol, suggesting a path for developing personalized diagnostics. The study also highlights the efficacy of saliva as an alternative to serum cortisol to facilitate cortisol measurement for efficient stress management.

Sonic hedgehog in oral squamous cell carcinoma: An immunohistochemical study.

BACKGROUND: Recent studies have revealed the involvement of hedgehog (Hh) signaling component in proliferation and invasive behavior of many carcinomas. AIM: This study aims to identify the expression of sonic Hh (SHH) protein of SHH pathway in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC) using SHH (H-160) (Santa Cruz, sc-9042) which could have therapeutic implication in future. MATERIALS AND METHODS: A total of 250 cases comprising 50 normal oral mucosa, 50 cases of oral epithelial dysplasia, 50 well, 50 moderate and 50 poorly differentiated OSCCs were included in the study. Immunohistochemical evaluation of SHH protein expression was conducted using monoclonal antibody. Interpretation of the expression was done by immunoreactive score of Remmele and Stegner (IRS) scoring method. STATISTICAL ANALYSIS: Chi-Square test was used to analyze the results. RESULTS: The study showed that SHH signaling molecules are highly expressed in OSCC, and their expression was mainly in the cytoplasm of epithelial cells. CONCLUSION: The SHH signaling component is associated with the pathological parameter in OSCC and oral epithelial dysplasia.

GSTM1 null polymorphism prevalence in tobacco users, oral leukoplakia and oral squamous cell carcinoma patients in South Indian population: A polymerase chain reaction study.

CONTEXT: Tobacco abuse is a well-known risk factor for potentially malignant disorders as well as oral squamous cell carcinoma. Factors that influence tobacco-exposed individuals developing a malignancy may include the combination of total tobacco exposure and genetic susceptibility. AIM: This study was undertaken to determine the prevalence of the glutathione S-transferase M1 (GSTM1) null polymorphism in oral leukoplakia and oral squamous cell carcinoma patients in South Indian population. SETTINGS AND DESIGN: This case-control study was conducted in hospital setting on South Indian population. MATERIALS AND METHODS: About 280 subjects with history of tobacco use, oral leukoplakia, oral squamous cell carcinoma were included in this study. Three milliliter of blood was collected and transported under cold cycle and taken for evaluation of GSTM1 null polymorphism using multiplex polymerase chain reaction. RESULTS AND DISCUSSION: On comparing the prevalence of GSTM1 null polymorphism among the group with subjects with habits and no oral lesions, oral leukoplakia, and oral squamous cell carcinoma, it was observed that there was a statistically significant association between GSTM1 null polymorphism and the different groups (P < 0.01). CONCLUSION: The lack of GSTM1 activity would make the oral tissues more susceptible to action of tobacco carcinogens and to the development of a high-grade level of dysplasia in oral leukoplakia and thereby increases the susceptibility of lesion to undergo malignant changes.

Association between serotonin transporter gene polymorphism and recurrent aphthous stomatitis.

BACKGROUND: Anxiety-related traits have been attributed to sequence variability in the genes coding for serotonin transmission in  the brain. Two alleles, termed long (L) and short (S) differing by 44 base pairs, are found in a polymorphism identified in the promoter region of serotonin transporter gene. The presence of the short allele  and SS and LS genotypes is found to be associated with the reduced expression of this gene decreasing the uptake of serotonin in the brain leading to various anxiety-related traits. Recurrent aphthous stomatitis (RAS) is an oral mucosal disease with varied etiology including the presence of stress, anxiety, and genetic influences. The present study aimed to determine this serotonin transporter gene polymorphism in patients with RAS and compare it with normal individuals. MATERIALS AND METHODS: This study included 20 subjects with various forms of RAS and 20 normal healthy age- and gender-matched individuals. Desquamated oral mucosal cells were collected for DNA extraction and subjected to polymerase chain reaction for studying insertion/deletion in the 5-HTT gene-linked polymorphic region. Cross tabulations followed by Chi-square tests were performed to compare the significance of findings, P < 0.05 was considered statistically significant. RESULTS: The LS genotype was the most common genotype found in the subjects with aphthous stomatitis (60%) and controls (40%). The total percentage of LS and SS genotypes and the frequency of S allele were found to be higher in the subjects with aphthous stomatitis as compared to the control group although a statistically significant correlation could not be established, P = 0.144 and 0.371, respectively. CONCLUSION: Within the limitations of this study, occurrence of RAS was not found to be associated with polymorphic promoter region in serotonin transporter gene.

Evaluation of Efficacy of Ultrasonography in the Assessment of Transcutaneous Electrical Nerve Stimulation in Subjects with Myositis and Myofascial Pain.

BACKGROUND: The study aimed to determine if ultrasonography of masseter can be used to evaluate the outcome of transcutaneous electrical nerve stimulation (TENS) in subjects with temporomandibular disorders (TMDs) such as myositis and myofascial pain. METHODS: Fifteen TMD subjects with myofascial pain/myositis who satisfied the RDC/McNeil criteria were included in the study. All the subjects were administered TENS therapy for a period of 6 days (30 minutes per session). The mouth opening (in millimeters) and severity of pain (visual analogue scale score) and ultrasonographic thickness of the masseter (in millimeters) in the region of trigger/tender areas was assessed in all the subjects both prior and post TENS therapy. A comparison of the pre-treatment and post-treatment values of the VAS score, mouth opening and masseter thickness was done with the help of a t-test. RESULTS: There was a significant reduction in the thickness of masseter muscle (P = 0.028) and VAS scores (P < 0.001) post TENS therapy. There was also a significant improvement in the mouth opening (P = 0.011) post TENS therapy. CONCLUSIONS: In the present study, ultrasonography was found to be an effective measuring tool in the assessment of TENS therapy in subjects with myositis and myofascial pain.

Prevalence of glutathione S-transferase M1 null polymorphism in tobacco users, oral leukoplakia and oral squamous cell carcinoma patients in South Indian population: A polymerase chain reaction study.

CONTEXT: Tobacco abuse is a well-known risk factor for potentially malignant disorders as well as oral squamous cell carcinoma (SCC). Factors that influence tobacco-exposed individuals developing a malignancy may include a combination of total tobacco exposure and genetic susceptibility. AIM: This study was undertaken to determine the prevalence of the glutathione S-transferase M1 (GSTM1) null polymorphism in oral leukoplakia and oral SCC patients in South Indian population. SETTINGS AND DESIGN: This case-control study was conducted in hospital setting on South Indian population. MATERIALS AND METHODS: Totally, 280 subjects with a history of tobacco use, oral leukoplakia, oral SCC were included in this study. Three milliliter of blood was collected and transported under cold cycle and taken for evaluation of GSTM1 null polymorphism using Multiplex Polymerase Chain Reaction. RESULTS AND DISCUSSION: On comparing the prevalence of GSTM1 null polymorphism among the group with subjects with habits and no oral lesions, oral leukoplakia and oral SCC, it was observed that there was a statistically significant association between GSTM1 null polymorphism and the different groups (P < 0.01). CONCLUSION: The lack of GSTM1 activity would make the oral tissues more susceptible to action of tobacco carcinogens and to the development of a high-grade level of dysplasia in oral leukoplakia and thereby increases the susceptibility of lesion to undergo malignant changes.

GSTM1 null polymorphism: a possible key for oral carcinogenesis

Introduction: Carcinogenesis is a multistep process and individual risk to development of cancer depends not only on environmental factors or extrinsic exposure to carcinogens but also on genetic susceptibility of an individual. In head and neck cancer, tobacco exposure and alcohol consumption are predominantly the most significant external factors for tumor formation. Individual's susceptibility to cancer may be partly explained by variability in enzymatic activities of metabolic genes. Mutations in genes concerned with production of enzymes for metabolism of tobacco products may lead to increased risk of carcinogenesis with respect to oral mucosa. Therefore variations in the expression of these genes due to heritable genetic polymorphisms might modulate the process of carcinogenesis by altering the exposure levels of tobacco derived carcinogens. Objective:This non systematic review summarizes current data available on the role of environment gene interaction in form of GSTM1 null polymorphism and oral carcinogenesis. Literature review: Relevant data was selected in order to summarize the studies conducted on GSTM1 null polymorphism and oral cancer. Conclusion: Relationship between GSTM1 null polymorphism in oral cancer needs to be established to confirm the role of environment gene interaction in oral carcinogenesis.

Primary tuberculosis: an unusual finding in the oral cavity.

The unusual involvement of the oral cavity in tuberculosis and the non-specific nature of its presentations mean that diagnosis of tuberculosis is often delayed and is an unexpected finding. The aim of this paper is to present a case of primary tuberculosis and discuss the implications of the manifestations and diagnosis of oral tuberculosis. This paper presents an unusual case of a painless, papillary, erythematous lesion in the anterior region of a maxillary edentulous ridge. When the patient concerned was first seen by the author, the lesion had been present for six months. There was cervical lymphadenopathy and it was diagnosed initially as a malignant lesion. Eventually, after biopsy and ultrasound examination, the diagnosis of primary oral tuberculosis was reached. The patient was managed solely by anti-tubercular drug therapy.

Comparative study between cervical vertebrae and hand-wrist maturation for the assessment of skeletal age / Estudo comparativo entre maturação de vértebras cervicais e da mão e punho para a determinação da idade esqueletal

Objectives: The aim of the study was to compare the cervical vertebrae maturity, using a lateral cephalogram,which is routinely taken before orthodontic treatment and is included as a part of the patient’srecord, with hand-wrist maturation method. Materials and methods: The study group comprised ofsixty subjects of Bangalore, Indian, origin, aged between 9-18 years. Hand wrist radiograph and lateralcephalograms were taken for these subjects. Assessment of skeletal maturation was done using SkeletalMaturity Indicators (SMI’s) from hand-wrist radiograph and Cervical Vertebrae Maturity Indicators(CVMI’s) from lateral cephalogram. A pair wise comparison for skeletal age assessment stages was doneusing Wilcoxon sign rank test and proportions was compared using Chi-Square test for statistical analysis.Results: Skeletal maturity assessed using the cervical vertebrae maturation index (CVMI) method andhand-wrist skeletal maturational index (SMI) method showed no statistical signifi cant difference for malesand females. However, females showed maturation at an early age as compared to males. Conclusions:Since properly utilized cervical vertebrae assessment provided a reliable assessment of pubertal growthspurt, it would be benefi cial to use a lateral cephalogram for skeletal maturity assessment and thereby eliminate the need for an additional radiograph (hand-wrist radiograph). This is cost effective and will alsoreduce the radiation exposure to the patient.

Objetivos: O objetivo do presente estudo foi comparar a maturidade das vértebras cervicais, por meio de umcefalograma lateral, que é rotineiramente obtido antes de tratamentos ortodônticos, com um método de medição dematuração de mão e punho. Materiais e métodos: O grupo estudado consistiu de sessenta indivíduos da região deBangalore, Índia, com idades entre 9 e 18 anos, de ambos os sexos. Radiografi as de mão e punho e cefalogramas emnorma lateral foram obtidos. A determinação da maturação esquelética foi determinada com o uso de Indicadoresde Maturidade Esquelética para radiografi as de mão e punho e Indicadores de Maturidade de Vértebras Cervicaispara cefalogramas em norma lateral. A comparação por pareamento para determinação da idade esqueletal foi feitautilizando o teste de ranqueamento de Wilcoxon e as proporções comparadas pelo teste Qui-Quadrado para análiseestatística. Resultados: A maturidade esquelética determinada pelo índice de maturação esquelética não mostroudiferença estatística signifi cante para homens e mulheres. Entretanto, em mulheres a maturação ocorreu em idademais precoce quando comparadas com os homens. Conclusões: Uma vez utilizado adequadamente, o método dedeterminação da maturidade das vértebras cervicais proporciona um indicativo confi ável do crescimento no estirãoda puberdade, o qual pode ser útil no estabelecimento da maturidade esqueletal por meio de cefalogramas laterais,eliminando assim a necessidade de radiografi as adicionais de mão e punho. Essa eliminação das radiografi as de mãoe punho é custo-efetiva e igualmente reduz a exposição do paciente à radiação ionizante.