Comparative Assessment of E-cadherin's Expression between the Metastatic and Non-metastatic Oral Squamous Cell Carcinoma: An Immunohistochemical Study

ABSTRACT Objective: To identify the clinicopathological correlation of E-cadherin expression in metastatic and non-metastatic oral squamous cell carcinoma (OSCC). Material and Methods: A total of 90 paraffin-embedded tissue sections of OSCC were retrieved from the registry. The total selected samples were 45 cases each from the primary lesions of metastatic and non-metastatic OSCC. One section was subjected to routine Hematoxylin and eosin stain and another to immunohistochemical analysis for E-cadherin expression. Results: A non-significant (p˃0.05) increased expression is seen in the non-metastatic group compared to the metastatic group, with predominantly membrane as the staining site in either group. However, the expression of E-cadherin did not reveal any statistically significant association with independent variables such as age, gender, and adverse habits of the patients (p>0.05). On the other hand, with respect to the histological differentiation of OSCC, a significant association (p<0.001) was observed with the well-differentiated type of metastatic OSCC. Conclusion: E-cadherin was useful to some extent in predicting regional metastasis. However, further studies using a panel of biomarkers with increased sample size may help us understand the process involved in metastasis.

Interrelation of the Risk Factors of NAFLD at various Stages of Progression of the glycemic Status on long-term Follow-up

Background: Though the risk factors for nonalcoholic fatty liver disease (NAFLD) are the same in diabetic and nondiabetic patients, their exact interrelation and weightage in the pathogenesis are unclear. Methods: A total of 130 nondiabetic and 170 diabetic patients with NAFLD [diagnosed on abdominal ultrasound and severity assessed by NAFLD fibrosis score (NFS)] were recruited from 2009 to 2018 and their baseline risk factors [body mass index (BMI), waist circumference (WC), blood pressure, presence of the metabolic syndrome (MS) and insulin resistance (IR) by Homeostasis Model of Assessment for Insulin Resistance (HOMA-IR), fasting blood glucose (FBG) and lipid levels, and hemoglobin A1c (HbA1c) levels] were noted and their interrelationship studied. The nondiabetic patients were prospectively followed up for alteration of glycemic status. Results: There was presence of high BMI (>23) in 66%, central obesity in 86% (of whom 59% had normal body weight), low high-density lipoprotein cholesterol (HDL) in 51%, high triglyceride (TG) in 68%, high low-density lipoprotein cholesterol (LDL) in 46.7%, IR in 86%, hypertension in 54%, and the MS in 57%. Hemoglobin A1c was high in 42.3% of nondiabetics. The prevalence of the MS was significantly higher in patients having IR and vice versa but only the MS and its components as also increasing age determined advanced fibrosis. After mean follow-up 7.3 years, progression from prediabetes (PD) to diabetes mellitus (DM) occurred in 10%, from normal glucose tolerance (NGT) to PD in 6.25%, and progression of NFS occurred in 16.9%. Advanced age, low HDL and high TG were associated with IR and were involved in glycemic progression as also obesity in progression from NGT to PD and central obesity from PD to DM. Conclusion: Though IR and MS go hand in hand in the pathogenesis of NAFLD in both diabetic and nondiabetic patients as well as in the glycemic progression of nondiabetic patients with NAFLD, the MS or its components have more weightage in determining the severity

A CBCT aided assessment for the location of mental foramen and the emergence pattern of mental nerve in different dentition status of the Saudi Arabian population / Avaliação auxiliada por CBCT para a localização do forame mentual e o padrão de emergência do nervo mentual em diferentes estados de dentição da população da Arábia Saudita

Objective: The anatomy of mental foramen (MF) is a noteworthy landmark during any surgical procedures in the inter-foraminal region. Thus, the study aims at evaluating the location of MF and the emergence pattern of MN in three status of dentition in Saudi Arabian population. Material and Methods: In a prospective study, we have analyzed 240 cone beam computed tomography (CBCT) for the location of MF and the emergence pattern of MN. The study comprising three groups, namely dentulous, partially edentulous and edentulous, each having eighty CBCT scans. We presented the data in percentages. The chi-square and McNemar's test were used for testing association and pair-wise analysis, respectively. Results: The most common location of MF was below the apex of the second premolar irrespective of dentition status, with 54.2% in right and 60% in the left side of the jaw. Among the dentition status, left side of the mandible has shown significant variation for the location of MF, whereas gender and age showed variation in the right side. Anterior loop (AL) (Type-III) the emergence pattern of MN was the highest in all dentition status, with 51.7% in right and 53.8% on the left side. The variation in the emergence pattern of MN in terms of gender and side of the jaw was statistically significant. Conclusion: In the Saudi Arabian population, the apex of second premolar and type III/AL was the most prevalent location of MF and the emergence pattern of MN, respectively (AU)

Introdução: Objetivo: A anatomia do forame mentual (FM) é de grande importância durante qualquer procedimento cirúrgico na região inter-foraminal. Por tanto, como objetivo o estudo visa avaliar a localização do FM e o padrão de emergência do NM em três estados de dentição na população da Arábia Saudita. Material e Métodos: Em um estudo prospectivo, analisamos 240 tomografias computadorizadas de feixe cônico (TCFC) para a localização do FM e o padrão de emergência de NM. O estudo compreendeu três grupos, a saber, dentados, parcialmente edêntulos e edêntulos, cada um com oitenta imagens de TCFC. Apresentamos os dados em porcentagens. O teste do Qui-quadrado e o teste de McNemar foram usados para testar associação e análise de pares, respectivamente. Resultados: A localização mais comum do FM foi abaixo do ápice do segundo pré-molar independente do estado da dentição, com 54,2% no lado direito e 60% no lado esquerdo da mandíbula. Dentre as condições da dentição, o lado esquerdo da mandíbula apresentou variação significativa para a localização dos FM, enquanto o sexo e a idade mostraram variação no lado direito. O padrão de emergência (Tipo III) da alça anterior (AL) do NM foi o mais alto em todos os estados de dentição, com 51,7% no lado direito e 53,8% no lado esquerdo. A variação no padrão de emergência de NM em termos de gênero e lado da mandíbula foi estatisticamente significativa. Conclusão: Na população da Arábia Saudita, o ápice do segundo pré-molar e tipo III / AL foi a localização mais prevalente de FM e o padrão de emergência de NM, respectivamente. (AU)

Study of Determinants of Various Anthropometric Measurements of Neonates at Birth.

Birth weight is considered as one of the most important factors that affect the neonatal mortality in both developing and developed countries. In addition, it is a significant determinant of post neonatal mortality, infant and childhood mortality and morbidity. This study was conducted to evaluate the various factors influencing anthropometric measurements of neonates at birth.METHODSThis is a hospital based cross sectional study consisting of neonates and their respective mothers delivered at Darbhanga Medical College, Laheriasarai, Bihar, during the period April 2018 to September 2019. Neonates were divided into three groups < 2500 gms, 2500-3500 gms, >3500 gms and these groups were studied in relation to the determining factors of mothers.RESULTSAmong 1000 babies, 56.3% were male and 43.7% were female. Mean birth weight was 2596.90 ± 542.79 gms ( ± SD). Mean birth weight was higher in males and LBW rate was higher in males. 37.3% of babies were LBW babies. Duration of gestation determines birth weight and other anthropometric parameters proportionately increase with birth weight. In the present study, 15.7% were preterm babies, and 1.8% of babies were post term babies. Factors like maternal age, weight, pregnancy weight gain, socio economic status, Muslim religion, maternal literacy, birth order (2nd onwards), male sex, singleton pregnancy, non-anaemic status, higher period of gestation and spacing had positive correlation with birth weight and negative correlation with LBW incidence. 1/3rd of LBW babies were preterm and 2/3rd were IUGR babies. In this study, anaemia and diabetes was 79.9% and 3% respectively. Maternal diabetes mellitus is an important risk factor for macrosomia.CONCLUSIONSBy avoiding teenage pregnancies, adapting family planning methods, providing good quality antenatal care, improving maternal nutrition, spacing of more than three years, correcting anaemia, early recognition of obstetric complications and timely intervention will reduce percentage of LBW babies, increase the mean birth weight and increase the other newborn anthropometric parameters at birth, which will lower the infant mortality and improve the survival.

Effective Reduction of Mental Trauma with a Multidisciplinary Approach to Treatment of Dental Trauma

The purpose of this case report and review is to present the successful management of complicated crown-root fracture of maxillary central incisor with a multidisciplinary approach. A 57-year-old male patient reported with a complaint of unpleasant appearance due to a broken 21. Clinical and radiological examination revealed a complicated oblique crown-root fracture extending below the gingival margin. The tooth was endodontically treated. Surgical crown lengthening with osseous recontouring was performed. After 7 days prefabricated temporary crown was cemented, 6 weeks after surgery fiber post was placed followed by composite core build up. The tooth was restored with a permanent restoration of porcelain fused to the metal crown with gingival porcelain. Examination after 3 months revealed the good periodontal health, esthetic, normal function and patient satisfaction. The key factor in the successful functional and esthetic rehabilitation of a complicated crown-root fracture is weighing of all the available options with a multidisciplinary approach.

Acute Painful Peripheral Diabetic Neuropathy: A Life Limiting Morbidity and it’s Treatment

Diabetes is a pandemic disease and the painful neuropathy is one of the most debilitating complications. It is characterized by constant, sudden onset burning pain along with paresthesia and intermittent sharp, shooting pain, usually involving the extremities. It handicaps the daily activities of the patient, interferes with sleep and also affects the mood. Case: We report the case of a 30-year-old male, with Type 1 DM who presented with complaints of painful neuropathy in the lower extremities. Conclusion: Painful neuropathy is an increasing threat and is often not detected or misdiagnosed due to inconsistent definitions and lack of diagnostic criteria. The knowledge of this condition in very important not only to diagnose it but also to appropriately manage a case, from the widely available pharmacological options.

Constellation of Oral Inflammatory Hyperplastic Lesions: Case Series with Review of Literature

Oral cavity, when subjected to various forms of chronic insults or microtrauma, often results in a hyperplastic lesion, commonly referred to as inflammatory reactive hyperplasia. This category includes various lesions such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma, and peripheral giant cell granuloma. They are primarily seen to develop in close proximity to the source of chronic irritant and have a close resemblance in terms of biological behavior and clinical presentation. Histopathologically, they display a common feature of hyperplastic fibrous tissue, but also have some variations like the presence of giant cells or aggregate of calcified mass depending on the histogenesis of the lesion. They were the most common tumor-like lesions to be seen in the oral cavity, familiarity with these lesions are of utmost importance. The present article portrays a series of 5 cases of different clinical forms of reactive hyperplasia with a brief literature review. The current manuscript is presented with an aim to enhance the knowledge about hyperplastic lesions.

Bacteriological Profile and Antibiotic Susceptibility Patterns in Neonatal Septicaemia in Tertiary Care Hospital

Introduction: Neonatal septicaemia has great role in morbidityand mortality among neonates. Neonatal mortality rate hasbeen reported in India as 17 per 1000 live births as per 2016-17 data. Neonatal septicaemia may be of early onset or lateonset depending of the age of the neonates. The mostcommon bacterial agents involved are Group B Streptococcus,Klebsiella pneumoniae, CoNS, Streptococcus pneumoniae,Haemophilus influenzae etc. Diagnosis is done by manymethods but the most important and absolute mode ofdiagnosis is blood culture.Aims and Objectives: The present study is done for thedetection of bacteriological profile and their antibioticsusceptibility pattern in case of neonatal septicaemia. Earlydiagnosis and specific treatment can save the lives of manyneonates who are suffering from neonatal septicaemia.Materials and Methods: The material used for the diagnosis isvenous blood of the suspected neonates. Blood culture methodis used for the diagnosis of Neonatal septicaemia. Repeatedsubculture is done on Blood agar, Nutrient agar, andMacConkey agar plates. Confirmation of organism is donethrough different biochemical tests. The antibiotic susceptibilitytesting was performed on Muller Hinton agar (MHA) by KirbyBauer disc diffusion method for bacterial isolates, as perclinical and laboratory standards institute (CLSI) guideline.Results: Total 206 cases of suspected neonatal septicaemiawere investigated in which 142 cases are found positive. Mostcommon organism isolated was Klebsiella pneumoniae(39.44%) than Staphylococcus aureus (33.8%), otherorganisms are Escherichia coli (9.86%), CoNS (8.48%),Pseudomonas (5.63%), Enterococcus (2.82%) etc. overallincidence of Gram negative organism (54.93%) was more thanGram positive organism (45.07%). As far as antibioticsensitivity pattern was concerned most of the organism were100% sensitive to imipenem, meropenem and colistin B andresistant to Ampicillin.Conclusion: Gram negative isolates were more common thanGram positive as the causative agents of neonatal sepsis. Themost common causative organism was Klebsiella pneumoniae.The other organisms isolated were Pseudomonas aeruginosa,Staphylococcus aureus, CoNS, etc. Most of the Gram negativeisolates were sensitive to Amikacin, Gentamycin, Ofloxacin andCiprofloxacin but were highly susceptible to Meropenem,Imipenem and Collistin-B. The Gram positive isolates werebetter sensitive to Amikacin, Cephalosporin, Ciprofloxacin andClindamycin but were less sensitive or resistant to Ampicillinand Erythromycin. They showed high susceptibility toTicoplanim, Linezolid, Vancomycin and Methicillin.

Spectrum of Microorganisms Causing Blood Stream Infection and the Antibiotic Sensitivity Pattern among Gram Negative Organisms: A Study from a Tertiary Care Centre in Bihar

Introduction: Incidence of Blood stream infection (BSI) is onthe rise and so is the increasing drug resistance amongdifferent organisms causing BSI. The trend of such infectionand the antibiotic sensitivity pattern may vary from region toregion.Materials and Methods: This study was conducted with thesame aim in which about 240 blood culture and sensitivityresults were noted from the records and were analysed to seethe current trend in this region. Our focus was mainly on Gramnegative organisms, as they have been found to causeincreased number of BSI.Results: Escherichia coli was the main Gram negativeorganism, and Staphylococcus aureus along with Coagulasenegative Staphylococcus (CoNS) were the main gram positiveorganisms isolated. Candida albicans was also found in four ofthe cases. The antibiotic sensitivity pattern of gram negativeisolates showed more than 90% susceptibility to higherantibiotics, whereas the susceptibility to other antibiotics werefound to be variable.Conclusion: E. coli is the main GNB causing the infectionfollowed by K. pneumoniae and P. aeruginosa. Increasingtrend of drug resistance is being noted by GNBs against mostcommonly used antibiotics.

Rheumatoid Arthritis- Unique Combination of Rheumatic, Cardiac and Pulmonary Manifestation of a Multisystem Disorder

Rheumatic arthritis is a common inflammatory disease but combination of cardiac valvular dysfunction involving aortic valve calcification, tricuspid regurgitation and right atrioventricular enlargement with interstitial involvement of lung is very rare manifestation of this multisystem disorder.

A rare clinical case of true hemifacial hyperplasia

Hemifacial hyperplasia (HFH) is an unusual congenital anomaly of debatable aetiology. It is characterised by facial asymmetry that is caused by a marked unilateral and localised overgrowth of facial soft tissues, bones and teeth. We report a case of true HFH with typical manifestations with a brief review of the clinical features and radiological findings associated with HFH, the differential diagnoses that should be considered and the available treatment options for HFH. It is hoped that this report will supplement the existing literature on this anomaly.

A clinico-epidemiological study of adult acne: Is it different from adolescent acne.

Background: Although acne is usually recognized as an adolescent skin disorder, the prevalence of adults with acne is increasing. There is surprisingly a paucity of data on the prevalence and clinical features of postadolescent acne in the adult Indian population. Aims: The clinical and epidemiological data of adult acne were evaluated with a view to establishing possible contributing etiological factors and observing whether clinical features differ from adolescent acne. Methods: Patients over the age of 25 years presenting with acne in a tertiary care hospital were included in the study. A detailed history and examination was carried out, with a stress on aggravating factors. Hormonal imbalances were investigated in females with alopecia, obesity, hirsutism and menstrual irregularity. Severity of acne and complications like scarring and psychological stress were included. Results: Out of 280 patients included in the study 82.1% were women and 17.9% were men. The mean age of the patients was 30.5 years. Persistent acne was observed in 73.2%, while it was late onset in 26.8%. Majority of the patients had inflammatory papular acne (55%), whereas comedonal acne was the least common (6%). Most common predominant site of involvement was cheek (81%), followed by chin (67%), and mandibular area (58.3%). Family history of acne was present in 38.6%. Premenstrual flare was seen in 11.7% of female patients, obesity in 6.4%, hirsutism in 5.7% and alopecia in 1.8%, but raised laboratory markers of hyperandrogenism were observed in only 3.08%. Scarring was observed in a majority of patients (76.4%) and psychological stress in 52.8% patients. Conclusion: Adult acne is predominant in women, and as compared to adolescent acne is more inflammatory, with involvement of the cheeks and lower half of the face, while comedones are rare. Facial scarring occurs in a majority and stress is common, which emphasizes that adult acne should not be neglected.

Autosomal-dominant osteopetrosis: An incidental finding.

Osteopetrosis is a descriptive term that refers to a group of rare, heritable disorders of the skeleton. Osteopetrotic conditions vary greatly in their presentation and severity, from just as an incidental finding on radiographs to causing life-threatening complications such as bone marrow suppression. It is caused by failure of osteoclast development and function. Osteopetrosis can be inherited as autosomal-recessive, autosomal-dominant or as X-linked traits, with the most severe forms being the autosomal-recessive ones. The severity of the disease is mild to moderate in the autosomal-dominant forms, with normal life expectancy. Diagnosis is largely based on clinical and radiographic evaluation. The present paper reports a case of autosomal-dominant osteopetrosis complicated by osteomyelitis with a short review of the condition.