Modified Frenectomy Technique to Eliminate the Aberrant LabialFrenum – A Report of Two Cases

Introduction: A modified frenal treatment for aberrant frenum is presented in this report to reduce scar tissue formation and maintain the attached gingiva. Description: The case report describes two cases in which a V-shaped incision removed the aberrant frenum and then the flaps of the frenum were sutured at the mid line. Results: The results showed reduced scar tissue in the mid line and the tissue healed with adequate attached gingiva. Take-Away Lessons: The modified frenotomy technique presented here is ideal for a large frenum that could expose the underlying connective tissue that could reduce the scar tissue formation.

Identification of multiple strains of Porphyromonas gingivalis using heteroduplex polymerase chain reaction in varying severity of chronic periodontitis

Aim: Research has demonstrated that there are multiple strains of Porphyromonas gingivalis with varying potency to cause periodontal disease. The current study aims at using heteroduplex polymerase chain reaction (PCR) to detect the strain diversity of P. gingivalis in periodontitis lesions of varying severity in a sample of the Indian population. Materials and Methods: Subgingival plaque samples were collected from 60 individuals with varying severity of chronic periodontitis and 30 individuals with a clinically healthy periodontium. The samples were subjected to PCR analysis to identify P. gingivalis, followed by heteroduplex analysis to identify the strain diversity in a given sample. Bacterial culture was carried out as a comparative standard. Results: Of the 56 samples that were positive for P. gingivalis by PCR, 54 samples yielded eight different heteroduplex patterns. Analysis of these patterns indicated that two strains of P. gingivalis were present in 41 individuals (45.6%) and three strains were present in 13 individuals (14.4%). Detection of P. gingivalis by PCR was significantly more in the periodontitis group as compared to the healthy group. Conclusions: Species-specific PCR and heteroduplex analysis provide a simple and accurate method to analyse the strain diversity of P. gingivalis. P. gingivalis was detected in both healthy periodontal sites as well as sites with periodontitis. The presence of two or three P. gingivalis strains was seen in 60% of the samples.

Management of an Epileptic Patient with Intellectual Disability: A Case Report and Clinical Guidelines.

Abstracts: Background: People with epilepsy have compromised livelihood due to the effect of disease and medications on the quality of life. Patients with accompanied intellectual disability have further difficulty to cope up in daily chores. Article highlights holistic management of patient having complex partial seizure with intellectual disability. Control of seizures along with the Psychological therapy was done to ameliorate standard of life. Management of patient consisted of history, oral prophylaxis, patient-parent counselling followed by non pharmacological treatment consisting of cognitive behaviour therapy, promotive autonomy therapy and promotive creativity therapy. She was coached in special school for physiotherapy, speech therapy, music therapy, yoga therapy and special education techniques. Team work between dentist, teachers and psychotherapists gave better accordance with each subsequent appointment. Apart from just teeth oriented approach one should focus on overall care. Timely referral to physician should be done for physical and mental ailments. The article also gives brief clinical guidelines on dental problems and there treatment in such patients along with seizure control of epileptic patients and behaviour management of patients with mental impairment.

A study of prescription pattern in the drug therapy of ear, nose, and throat infections at a tertiary care hospital in Mangalore.

Background: Diseases of the ear, nose, and throat (ENT) constitute among the most common causes of hospital visits worldwide and account for most of the antibiotics prescribed and used. They are responsible for significant school and work absenteeism and have generated 94.6 disability-adjusted life years lost worldwide. Due to the high incidence of these diseases and the different varieties of drugs in use, it becomes imperative for us to know the present prescribing patterns, so that appropriate adjustments can be made for the benefit of patients. Methods: Over a period of 1-year, the outpatient department (OPD) records of 608 patients with ENT infections, reporting to the ENT OPD of Justice K S Hegde Charitable Hospital, Deralakatte, Mangalore, were scrutinized and the data collected in a specially designed proforma. Descriptive analysis of the data was done. Results: Of the total 608 prescriptions analyzed, 309 (50.8%) belonged to male patients and 299 (49.2%) belonged to female patients. Highest numbers of patients were in the age group of 16-25 years (29.44%). The most common diseases reported were chronic suppurative otitis media (19.24%), followed by otitis externa (13.49%) and furunculosis (9.87%). Average number of drugs per prescription was found to be 3.0. Oral antibiotics were prescribed to 540 patients (88.81%). Most common antibiotics prescribed were amoxicillin-clavulanate (53%), levofloxacin (17%), and cefixime (14%). Antihistamines were prescribed in 52.47% prescriptions, and nonsteroidal anti-inflammatory drugs were prescribed to 298 patients (49.01%). Conclusion: This study shows that the diseases were treated rationally in accordance with the standard guidelines of therapy.

Comparison of the effi cacy of sitagliptin with pioglitazone on dexamethasone-induced hepatic steatosis, dyslipidemia, and hyperglycemia in albino rats.

Background: Sitagliptin is a dipeptidyl peptidase type 4 inhibitor. This study was done to assess the insulin-sensitizing effect of sitagliptin on Wistar albino rats by means of surrogate measures. Methods: There were four groups of six rats each. First group received dexamethasone alone in a dose of 8 mg/kg intraperitoneally for 6 days to induce metabolic changes and considered as dexamethasone control. Second group received sitagliptin 100 mg/kg orally 6 days before dexamethasone and 6 days during dexamethasone administration. Third group received pioglitazone 45 mg/kg orally 6 days before dexamethasone and 6 days during dexamethasone administration. Fourth group did not receive any medication and was considered as normal control. Fasting blood sugar, lipid profi le, blood sugar 2 hrs after glucose load (postprandial blood sugar), liver weight, liver volume, and histopathological analysis were done. Results: The effects of sitagliptin were compared with that of pioglitazone. Dexamethasone caused hepatomegaly, dyslipidemia, and hyperglycemia. Both pioglitazone and sitagliptin signifi cantly reduced hepatomegaly, dyslipidemia, and hyperglycemia (p<0.01). Reduction of blood sugar levels after glucose load was signifi cant with pioglitazone in comparison to sitagliptin (p<0.01). Conclusions: Sitagliptin has comparable effi cacy to pioglitazone in dexamethasoneinduced hepatomegaly, dyslipidemia, and fasting hyperglycemia

Association of recurrent aphthous ulcers with stress among students in an Indian Dental Institution.

Background: Recurrent aphthous ulcers are painful oral lesions with no proven effective treatment. A definitive cause of these ulcerations still remains elusive. It is believed that psychological stress may be a significant contributor. Aim: The aim of the present study was to determine whether there was any significant association of Recurrentaphthous ulcers with episodes of stress by determining the prevalence of ulcers and levels of stress tolerance among dental students. Materials and methods: A cross sectional survey was carried out on 341 students of Manipal College of Dental Sciences, Manipal, India by distributing questionnaires. The questionnaire had two sections, the first part dealt with ulcers and the later part comprised of a perceived stress scale. The data collected was analyzed with Independent sample t test and ANOVA with post hoc Tukey’s test using the SPSS 16 version software. Results: Prevalence of ulcer was found to be 66.9%. Comparison of mean stress scores between the ‘ulcer-experienced’ and ulcer-free groups showed no difference. Assessment of stress among undergraduates, interns and post graduates who had reported ulcer experience revealed that interns were able to handle the stressful situations significantly better than under graduates and post graduates. Conclusion: The present study did not show any association between episodes of ulcers and stressful events.

Biotypes and virulence factors of Gardnerella vaginalis isolated from cases of bacterial vaginosis.

The present study was conducted to correlate the biotypes of Gardnerella vaginalis strains isolated from cases of bacterial vaginosis and their virulence factors. Thirty-two strains of G. vaginalis isolated from cases of bacterial vaginosis were biotyped. Adherence to vaginal epithelial cells, biofilm production, surface hydrophobicity, phospholipase C and protease activity were tested on these isolates. Biotype 1 was the most prevalent (8; 25%), followed by biotype 2 (7; 21.9%) and biotypes 5 and 8 (5; 15.6%). We did not find any statistical correlation between G. vaginalis biotypes and its virulence factors. Virulence factors expressed by G. vaginalis were not associated with a single biotype.

Primary Renal Leiomyosarcoma: Case Report and Literature Review

Primary leimyosarcoma of the kidney is extremely rare. The management is unclear due to the limited literature on the subject. The diagnosis should be considered when imaging shows a relatively hypovascular tumor involving one renal pole; with atypical features on microscopy. We report a renal leiomyosarcoma in a 68 year old man; who underwent right radical nephrectomy. A tumor-free surgical margin is the most important prognostic factor. Although various modalities of adjuvant treatment have been tried; the overall prognosis is poor as the tumor is highly aggressive

Significance of MRSA strains in community associated skin and soft tissue infections.

The study was conducted to determine the antibiotic susceptibility profile of community-associated methicillin resistant Staphylococcus aureus (CAMRSA) strains isolated from infections. S. aureus strains were isolated from clinical specimens using the standard procedures. CDC definition was used to classify CAMRSA. Antibiotic susceptibility test was done using Kirby-Bauer disk diffusion method. Double disk diffusion method (D-test) was used to detect inducible macrolide, lincosamide and streptogramin B resistance (inducible MLS B resistance ) . A total of 83 CAMRSA were isolated from abscesses and other skin infections in persons without known risk factors for MRSA infection. All CAMRSA were susceptible to vancomycin. Out of 83 CAMRSA, 13 (15.65%) were D-test positive (inducible MLS B positive) and 6 (7.23%) were positive for constitutive MLS B resistance. Eight strains (9.63%) were resistant to tetracycline and 26 (31.32%) strains were resistant to erythromycin. Increased rate of inducible clindamycin resistance among CAMRSA indicates the importance of identification of such strains by D test to avoid treatment failure when clindamycin is used.

Effect of stress on production of heat labile enterotoxin by Escherichia coli.

Enterotoxigenic Escherichia coli (ETEC) is an important pathogen responsible for secretory diarrhoea. The production of heat labile enterotoxin (LT), by ETEC, is largely responsible for the pathogenesis of diarrhoea. In the present study we investigated the effect of stress factors such as temperature, pH, osmotic stress and nutritional limitation on the production of LT by ETEC using in-house GMI-ELISA. Four strains of E. coli consisting, one standard strain MTCC 723 and three clinical isolates were used in the study. Maximum amount of LT (OD 3.285) was produced at 37 0 C followed by 40 0 C (OD 3.305). Growth of E. coli in medium with pH 8.6 resulted in maximum amount of LT production (OD 3.489). LT was not detectable when bacteria were grown in medium with pH ≤7.2 and ≥ 9.2. Sodium chloride concentration of 0.2 M stimulated maximum amount of LT production. Maximum amount of LT was produced when the bacteria were grown in medium containing 2.5g/l of glucose. All the stress factors had a significant effect on the LT production by E. coli , though quantitative differences in the various strains were observed.

Factors affecting the nasal carriage of methicillin-resistant Staphylococcus aureus in human immunodeficiency virus-infected patients.

Human immunodeficiency virus-infected patients attending skin outpatient department were studied for nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and associated factors affecting nasal colonization. Nasal swabs were used for isolation of S. aureus. MRSA were detected by agar screen and agar dilution methods. Careful examination for dermatoses was carried out. Forty-six of the 60 (76.67%) outpatients with HIV infection were colonized with S. aureus in the anterior nares. Significant number of S. aureus carriers were in the 31-40 year age group. Methicillin resistance was found in eight (17.39%) isolates. Of the 46 S. aureus strains, 29 (63%) were resistant to erythromycin, 69.5% to co-trimoxazole and 41.3% to ciprofloxacin. Co-trimoxazole use was found to be a risk factor for S. aureus carriage ( P = 0.0214) but not for methicillin resistance. Hospital stay for more than 10 days was a risk factor for methicillin resistance whereas stay for more than 25 days was found to be a highly significant risk factor. Dermatophytosis and herpes simplex virus infection were other risk factors for nasal carriage of S. aureus.

Effect of exposure to hydrogen peroxide on the virulence of Escherichia coli.

PURPOSE: To eliminate pathogenic bacteria, the host presents conditions that are stressful for bacteria. Oxidative stress arises when the concentration of pro-oxidants like hydrogen peroxide (H2O2 ) and superoxide anion increases to a level over the basal defence capacity of the cell. In the present study, we studied the effect of oxidative stress on the production of certain virulence factors by Escherichia coli . METHODS: E. coli was exposed to oxidative stress by growing in the presence of different concentrations of H2O2 . The effect of oxidative stress on the expression of surface hydrophobicity, adherence, haemolysin production, serum resistance and phagocytosis was studied. RESULTS: Oxidative stress caused a significant decrease in the expression of all the virulence factors of E. coli . CONCLUSIONS: Synthesis of virulence factors can be significantly altered by oxidative stress and such changes may affect the pathogenicity of E. coli.

Virulence factors and drug resistance in Escherichia coli isolated from extraintestinal infections.

PURPOSE: To determine the virulence factors produced by Escherichia coli isolated from extraintestinal infections, to study the drug resistance pattern in E. coli with special reference to extended spectrum beta -lactamase (ESBL) and to evaluate screening methods for ESBL. METHODS: A total of 152 isolates of E. coli from various extraintestinal infections were screened for virulence factors such as haemolysin, surface hydrophobicity, serum resistance and protease. All the isolates were also studied for antibiotic susceptibility pattern using modified Kirby Bauer disk diffusion method. ESBL production was screened by standard disk diffusion method and confirmed using phenotypic confirmatory method. RESULTS: Among 152 isolates, 36 (23.7%) were haemolytic, 42 (27.6%) were hydrophobic, 132 (86.8%) were serum resistant and only four were positive for protease. Multiple virulence factor were observed in 67 (44%) of isolates. Seventy-nine (51.4%) isolates produced ESBL. ESBL producing isolates showed multidrug resistance. There was a significant association ( P E. coli . CONCLUSIONS: The present study shows the expression of virulence factors and multidrug resistance in E. coli isolated from various extraintestinal infections. The study also shows that appropriate methods of detecting drug resistance and ESBL production are required for the judicious use of antibiotics in managing these infections.

Phenotypic switching and its influence on expression of virulence factors by Candida albicans causing candidiasis in human immunodeficiency virus-infected patients.

PURPOSE: The purpose of the present study was to determine the degree of expression of virulence factors such as adherence, cell surface hydrophobicity (CSH) and production of proteinase by different morphological forms of Candida albicans causing oral candidiasis in human immunodeficiency virus (HIV)-infected individuals. METHODS: C. albicans 3153A and two strains isolated from oral thrush in HIV infected individuals were induced to undergo phenotypic switching by exposure to UV light and the degree of expression of virulence factors by the different morphological forms was studied. RESULTS: Three different morphological forms of C. albicans were obtained namely, star (S), wrinkled (W) and ring (R) types from the original smooth (O) variety. It was found that proteinase production was greatest with the W type followed by the R type and O type. The S type produced the least proteinase. Expression of cell surface hydrophobicity and adherence was greatest in the O type followed by the R and then the W type and finally the S type. CONCLUSIONS: The differential expression of virulence factors occurs with different phenotypic forms of C. albicans and this may provide a particular morphological type with a distinct advantage over other types in causing candidiasis.

Bacterial adherence and humoral immune response in women with symptomatic and asymptomatic urinary tract infection.

PURPOSE: To determine the role of humoral immune response and bacterial adherence in the pathogenesis of symptomatic and asymptomatic urinary tract infection in women. METHODS: The study population consisted of 30 women with symptomatic UTI, 30 women with asymptomatic UTI and 30 healthy women as controls. Bacterial adherence to vaginal epithelial cells was studied and the concentration of serum and urine antibodies to mixed coliform antigen and clinical isolate was determined by ELISA. Surface hydrophobicity of the urine isolates was determined. Student's unpaired t test and Pearson's correlation coefficient test were used in the statistical analysis. RESULTS: Compared to asymptomatic UTI, significantly more number of bacteria adhered to the epithelial cells of women with symptomatic UTI (P< 0.001). All cases of UTI had significantly high concentration of urinary IgG antibody to mixed coliform antigens. Asymptomatic UTI cases had higher concentrations of urinary IgG, IgM and IgA antibodies to clinical isolate. Concentration of sIgA level was more in symptomatic UTI. Significant correlation was observed between urinary IgG and adherence of clinical isolate in case of asymptomatic UTI. CONCLUSIONS: The present study showed that greater receptivity of epithelial cells to bacteria may increase the susceptibility to UTI. Humoral immune response and local immunity may modify the pathogenesis of UTI.