Differential expression of CK7, CK20, CDX2 in intestinal and pancreatobiliary types of preriampullary carcinoma

Context: Incidence of periampullary carcinoma is low, approximately 0.5–2% of all gastrointestinal malignancies. Histologic subtyping has a prognostic bearing. The purpose of this study is to differentiate periampullary carcinomas based on immunohistochemistry (IHC) by using cytokeratin 7 (CK7), cytokeratin 20 (CK20), caudal type homeobox 2 (CDX2). Aims: To analyze the usefulness of IHC as single/panel of markers that included CK7, CK20, and CDX2. Settings and Design: This was a prospective study done from January 2017 to September 2018. Subjects and Methods: A total 50 pancreaticoduodenectomy specimens were evaluated and classified as intestinal (INT) and pancreaticobiliary (PB) types based on their morphological and immunohistochemical features, respectively. The morphologic subtypes, expression of IHC markers were correlated with different histologic parameters. Statistical Analysis: Chi-square test was used to study the association between different IHC markers with histologic parameters. Probability (P) values <0.05 were regarded as statistically significant. Results: The expression of CK7, CK20, CDX2 were studied in 50 cases to classify them as INT and pancreatobiliary subtypes. CK7 has high sensitivity (88.2%), CDX2 has high specificity (96.4%), CK20+/CDX2+ has both high sensitivity (94.2 percent) and specificity (89.2 percent) in differentiating INT from pancreatobiliary subtypes. The morphologic subtypes showed correlation with two variables (tumor grade, pathologic T stage). CK20 and CK20/CDX2 expression showed a positive correlation with tumor grade, pathologic T staging, and lymphovascular invasion. Conclusions: In conclusion, morphological classification can significantly discriminate histologic types, IHC plays a moderate role. However, the combined expression of CK20 and CDX2 is helpful in subtyping.

Detection of paroxysmal nocturnal hemoglobinuria-phenotype in patients with chronic lymphocytic leukemia and multiple myeloma.

Background : Paroxysmal nocturnal hemoglobinuria (PNH) results due to decrease or absence of glycosylphosphatidylinositol-anchored (GPI) molecules, such as CD55 and CD59, from the surface of the affected cells. PNH-phenotype has been described in various hematological disorders, mainly aplastic anemia and myelodysplastic syndromes; recently it has been reported in patients with lymphoproliferative syndromes and multiple myeloma (MM). Materials and Methods : We evaluated the presence of CD55 negative and/or CD59 negative red blood cell (RBC) populations in newly diagnosed treatment naive-54 chronic lymphocytic leukemia (CLL) and 29 MM patients by flow cytometry. Results : PNH-phenotype was not reported in any patient; however, RBC populations deficient in CD55 were detected in 16.66% (9/54) CLL and 6.89% (2/29) MM patients. Clinical presentation or the hematological parameters did not show any relationship with the presence of CD55 deficient RBC population. Conclusion : Our study showed absence of PNH-phenotype in patients with CLL and MM; however, isolated CD55 deficient RBC were identified in both CLL and MM. Larger prospective studies by other centers, including simultaneous analysis of granulocytes for the presence of PNH-phenotype, are needed to corroborate these findings and to work out the mechanisms and the significance of the existence of this phenotype in these patients.

Comfort And Acceptability of Different Types of Mouthguards Among 7-12 Years Old Children At Skating Rink.

Participation in sports activities, besides having many beneficial effects, often increases the risk of traumatic injury to the dental and oral tissues. The single most important device for protecting the teeth and mouth during athletic activities is the use of an intraoral mouth guard. The intention of this study was to survey 7-12 year old children participating in skating, mainly to evaluate the significance of utilization of mouth guard wear over a period of 8-10 weeks and also to determine the acceptability of the three different types of mouth guards used. The results drawn from this study showed that 13% orofacial injuries were experienced by children during skating, and irrespective of the type of mouth guard used over a period of 10 weeks, none of the skaters had experienced an oral injury and this shows a significant finding with p<0.01 (Z test for proportions). The custom mouth guard was readily accepted by the skaters and their extent of use was also high when compared to mouth formed and stock mouth guards with p value < 0.05, which is statistically significant.

Fluoride and bacterial content of bottled drinking water versus municipal tap water.

Background: Water is a divine gift. People quench their thirst without questioning the source of water. But, apprehension about contaminants in municipal water supplies along with increased fear of fluorosis made bottled drinking water as one of the important tradable commodities. Objectives: The objectives of the study were to determine and compare the fluoride and bacterial contents of commercially available bottled drinking water and municipal tap water in Davangere city, Karnataka. Materials and Methods: Fifty samples of 10 categories of bottled drinking water with different batch numbers were purchased and municipal water from different sources were collected. Fluoride levels were determined by an ion-selective electrode. Water was cultured quantitatively and levels of bacteria were calculated as colony-forming units (CFUs) per milliliter. Results: Descriptive analysis of water samples for fluoride concentration was in the range of 0.07-0.33 for bottled drinking water, Bisleri showing the highest of 0.33. A comparison of the mean values of microbial count for bottled drinking water with that of municipal tap water showed no statistically significant difference, but was more than the standard levels along with the presence of fungus and maggots. Conclusion: The fluoride concentration was below the optimal level for both municipal tap water and bottled drinking water. CFUs were more than the recommended level in both municipal tap water and bottled drinking water.

Proton magnetic resonance spectroscopy of brain in obstructive sleep apnoea in north Indian Asian subjects.

Background & objectives: Repeated apnoeic/hypoapnoeic episodes during sleep may produce cerebral damage in patients with obstructive sleep apnoea (OSA). The aim of this study was to determine the absolute concentration of cerebral metabolites in apnoeic and non-apnoeic subjects from different regions of the brain to monitor the regional variation of cerebral metabolites. Methods: Absolute concentration of cerebral metabolites was determined by using early morning proton magnetic resonance spectroscopy (1H MRS) in 18 apnoeic patients with OSA (apnoeics) having apnoea/hypopnoea index (AHI) >5/h, while 32 were non-apnoeic subjects with AHI< 5/h. Results: The absolute concentration of tNAA [(N-acetylaspartate (NAA)+N-acetylaspartylglutamate (NAAG)] was observed to be statistically significantly lower (P<0.05) in apnoeics in the left temporal and left frontal gray regions compared to non-apnoeics. The Glx (glutamine, Gln + glutamate, Glu) resonance showed higher concentration (but not statistically significant) in the left temporal and left frontal regions of the brain in apnoeics compared to non-apnoeics. The absolute concentration of myo-inositol (mI) was significantly high (P<0.03) in apnoeics in the occipital region compared to non-apnoeics. Interpretation & conclusions: Reduction in the absolute concentration of tNAA in apnoeics is suggestive of neuronal damage, probably caused by repeated apnoeic episodes in these patients. NAA showed negative correlation with AHI in the left frontal region, while Cho and mI were positively correlated in the occipital region and Glx showed positive correlation in the left temporal region of the brain. Overall, our results demonstrate that the variation in metabolites concentrations is not uniform across various regions of the brain studied in patients with OSA. Further studies with a large cohort of patients to substantiate these observations are required.

An analysis of concentration of sucrose, endogenous pH, and alteration in the plaque pH on consumption of commonly used liquid pediatric medicines.

Background: Many parents are often unaware of the hidden, added sugars in many foods and drinks including pediatric liquid medicines; thus, hidden sugar in the form of pediatric medications has not been focused upon as cariogenic agents. Objective: (i) assess concentration of sucrose in six pediatric drugs, (ii) determine endogenous pH of these drugs, and (iii) estimate drop in the plaque pH in the oral cavity in first 30 minutes after consumption of the drugs. Materials and Methods: Ten adult volunteers with mean age of 22 years were double blinded for the study. Concentration of sucrose was assessed by volumetric method at Department of Chemical Branch of Engineering. Endogenous pH and drop in the plaque pH after consumption of the drugs were assessed using digital pH meter. Statistical analysis: SPSS software was used to assess the pH level at different time intervals and expressed as mean +/- SD. Changes in pH were assessed by one-way ANOVA followed by Wilcoxons signed rank test. P-value was set at 0.05. Result: There were varying amounts of fermentable sucrose detected in the drugs; all the drugs were acidic. There is a significant drop of plaque pH after consumption of the drug. Conclusion: These sweeteners along with their low endogenic pH form a high cariogenic formulation. Thus, nonsucrose (noncariogenic) or sugar-free medications are needed to be prescribed along with proper oral hygiene care to the children under medication.

Comparative evaluation of shear bond strength of two self-etching adhesives (sixth and seventh generation) on dentin of primary and permanent teeth: An in vitro study.

Aim: The present study was undertaken to compare and evaluate shear bond strength of two self-etching adhesives (sixth and seventh generation) on dentin of primary and permanent teeth. Materials and Methods: Flat dentin surface of 64 human anterior teeth (32 primary and 32 permanent) divided into four groups of 16 each. Groups A and C were treated with Contax (sixth generation), while groups B and D were treated with Clearfil S3 (seventh generation). A teflon mold was used to build the composite (Filtek Z-350) cylinders on the dentinal surface of all the specimens. Shear bond strength was tested for all the specimens with an Instron Universal Testing Machine. Data were statistically analyzed using one-way ANOVA for multiple group comparison, followed by student's unpaired 't' test for group-wise comparison. Results: There was no statistically significant difference in shear bond strength among the study groups except that primary teeth bonded with Contax exhibited significantly lesser shear bond strength than permanent teeth bonded with Clearfil S3. Conclusion: This study revealed that Clearfil S3 could be of greater advantage in pediatric dentistry than Contax because of its fewer steps and better shear bond strength in dentin of both primary and permanent teeth.

Comparison of digital radiography, decalcification, and histologic sectioning in the detection of accessory canals in furcation areas of human primary molars.

Although the terms lateral secondary and accessory canals are often used interchangeably they mean different things. The accessory canal is derived from the secondary canal branching off to the periodontal ligament in apical sections. Different methodology was used to study the accessory canals. Decalcification method appeared to the important in studying the accessory canals as compared to digital radiography and histological sectioning.

Chocolate mouth rinse: Effect on plaque accumulation and mutans streptococci counts when used by children.

Background: Glucosyltransferases (GTF) play an important role in the adherence of bacteria to acquired pellicle. Cocoa bean husk extract (CBHE) has been shown to possess anti-glucosyltransferase and antibacterial activity. Aim: This study aimed to evaluate the effect of CBHE on plaque accumulation and mutans streptococcus count when used as a mouth rinse by children. Materials and Methods: Scaling of the teeth of the selected children was done and the children were instructed to refrain from their routine oral hygiene practices till the morning of the fourth day; they were instead given a placebo mouth rinse for use during this period. On the fourth day, saliva was collected from each subject for microbiological analysis and plaque was disclosed and scored using the modified Quigley and Hein plaque index; later, the teeth were cleaned. After 1 week, scaling of the subjects was done and they were given CBHE mouth rinse to rinse their mouth, following the above protocol. The data was statistically analyzed using Wilcoxon's signed rank test. Results: There was a 20.9% decrease in mutans streptococci counts and a 49.6% decrease in plaque scores in the CBHE group as compared to the placebo group, which was highly significant (P value Conclusion: CBHE is highly effective in reducing mutans streptococci counts and plaque deposition when used as a mouth rinse by children.

Papillon-Lefevre syndrome: Report of two cases in the same family.

Papillon-Lefevre syndrome is a very rare syndrome of autosomal recessive inheritance characterized by palmar-plantar hyperkeratosis and early onset of a severe destructive periodontitis, leading to premature loss of both primary and permanent dentitions. Various etiopathogenic factors are associated with the syndrome but a recent report has suggested that the condition is linked to mutations of the cathepsin C gene. Two cases of Papillon-Lefevre syndrome in the same family, having all of the characteristic features, are presented. An 11-year-old girl and a 9-year-old boy presented with the complaints of loose teeth. Both expressed hyperkeratosis of palms, soles, and knees. Severe generalized periodontal destruction, with mobility of teeth, was evident on intraoral examination; orthopantomograph examination showed severe generalized loss of alveolar bone in both the patients.

Comparison of antibacterial activity of three fluorides- and zinc-releasing commercial glass ionomer cements on strains of mutans streptococci: an in vitro study.

The purpose of present study was to investigate the antibacterial activity of three commercially available fluoride- and zinc-releasing glass ionomer cements on strains of mutans streptococci. Three glass ionomers (Fuji II Conventional, Fuji II Light Cure, and Fuji IX) were used. The antibacterial effect of glass ionomer cements were estimated by anaerobically growing mutans streptococci on a selective medium by inoculating human saliva and measuring the inhibition zones around the glass ionomer discs on the medium. Fluoride and zinc release were measured and compared with the antibacterial activity. The results, when statistically analyzed, showed a direct correlation between fluoride release and antibacterial activity, but there was no correlation between zinc release and antibacterial activity.

Orthodontic uprighting of impacted mandibular permanent second molar: a case report.

The mandibular second molars can become impacted beneath the crown of the first molars due to various causes and fail to erupt normally. Presented herewith is a case report of orthodontic uprighting of a mesioangular impacted mandibular right permanent second molar. Though various treatment options were available, an uprighting push spring appliance was used as it is easy to fabricate and produces distal tipping and uprighting of the impacted tooth without the necessity of surgical assistance, bone removal, or splinting. The uprighting of the mandibular second molar was achieved within two months.

Assessment of atmospheric microbial contamination in a mobile dental unit.

INTRODUCTION: Bioaerosols are important considerations in infection control as well as in occupational health. Bioaerosols may carry potentially hazardous microbes, viruses, fungi, allergens, and other toxic substances that may harm the dental operator, patient, and the dental assistant by causing nosocomial infections. OBJECTIVE: To assess the level of atmospheric microbial contamination before, during, and after dental treatment procedures in the dental operatory of a mobile dental unit (MDU). MATERIALS AND METHODS: The study included three treatment sessions on different working days, with an interval of one month. The MDU was fumigated before the start of the study. Brain Heart Infusion Agar with 5% sheep blood was used to collect the gravitometric settling of aerosols produced before, during, and after dental treatment procedures. The agar plates were sent for aerobic and anaerobic culture. RESULTS: The results showed that atmospheric microbial contamination (CFUs/plate) was 4 times higher during working sessions as compared to the levels before the working sessions. At the end of the working day, aerosols decreased by almost 3 times that seen during work. CONCLUSION: The aerosols increased during and after work sessions. This shows the increased risk of transmission of infectious agents to the dentists who work in the MDU. Hence, all necessary preventive measures should be advised and need to be followed strictly.

Estimation of trace elements in sound and carious enamel of primary and permanent teeth by atomic absorption spectrophotometry: an in vitro study.

The influence of trace elements on the prevalence of caries is a complex subject. However, the demonstration of an inverse relationship between caries prevalence and fluoride (F) intake indicates the potential effect of trace elements on caries. AIMS AND OBJECTIVES: This in vitro study sought to estimate and compare the trace element concentrations in sound and carious enamel of primary and permanent teeth. MATERIALS AND METHODS: Forty sound and carious primary and permanent teeth, extracted from children and adolescents of Davangere city, were collected. The teeth were divided into four groups (of ten each) and enamel samples were prepared by mechanical grinding. The trace elements were estimated using atomic absorption spectrophotometer. RESULTS AND CONCLUSIONS: The results of our study showed the presence of 18 trace elements (F, Sr, K, Al, Si, Ni, B, Fe, Cu, Mn, Co, Cr, Zn, Mg, Se, Pb, Mo, and V) in the enamel of sound and carious primary and permanent teeth. The mean, standard deviation, and range (at 95% confidence level) were calculated for each element. The concentrations of F, Sr, and K were significantly ( P <0.05) higher in sound enamel of permanent teeth than in sound enamel of primary teeth. The concentrations of F, Sr, K, Al, and Fe were significantly ( P <0.05) higher in sound enamel of permanent teeth than in carious enamel of permanent teeth. The concentrations of F, K, and Si were significantly ( P <0.05) higher in sound enamel of primary teeth than in carious enamel of primary teeth.

Comparison of antibacterial properties of two fluoride-releasing and a nonfluoride-releasing pit and fissure sealants.

Occlusal pits and fissures are the most susceptible sites for the development of dental caries and prevention is difficult in the areas of occurrence. Although only 12.5% of all the tooth surfaces are occlusal, these surfaces develop more than two-thirds of total caries experienced by children. The fate of the bacteria is of significance when they are inadvertently sealed by a dental sealant. This study aimed in examining the antibacterial properties of three commercially available sealants, viz., Teethmate-F, Helioseal-F and Helioseal. Antibacterial testing was done by disc diffusion method. Selective agars were used to grow Streptococcus mutans and Lactobacillus acidophilus, which are implicated in the pathogenesis of dental caries. Statistical analysis was carried out using student's t test. The study proved that Helioseal-F and Helioseal did not possess antibacterial properties and Teethmate-F was the only sealant that showed antibacterial properties.

Effect of antiasthmatic medication on dental disease: dental caries and periodontal disease.

The prevalence of asthma has been increasing since the 1980s. Asthma and tooth decay are the two major causes of school absenteeism. There are few studies present in the literature. The objectives of the present study were to know the severity of dental caries and periodontal problems in children before and after taking antiasthmatic medication. The present study was conducted on 105, six- to fourteen-year-old asthmatic children to determine the condition of their dental caries and their periodontal status before and after taking antiasthmatic medication, for a period of 1 year and these were matched with their controls. The results showed that salbutamol inhaler shows increased caries rate with high significance over other groups, which was followed by salbutamol tablets and beclamethasone inhaler respectively. It has been concluded that antiasthmatic medication has its effects on dental caries and periodontal disease and asthmatic patients are recommended to adopt more precautionary oral hygiene practices and keep their caries activity and periodontal health under constant check.

Garre's sclerosing osteomyelitis.

Garre's sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults. This disease entity is well-described in dental literature and is commonly associated with an odontogenic infection resulting from dental caries. This paper describes a case of Garre's osteomyelitis in a 10-year-old boy, in whom the condition arose following pulpoperiapical infection in relation to permanent mandibular right first molar. Clinically the patient presented with bony hard, non-tender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance. The elimination of periapical infection was achieved by endodontic therapy and the complete bone remodeling was seen radiographically after three months follow-up.

Knowledge and attitude of 2,000 parents (urban and rural - 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere.

It is well recognized today that for long-term success, the management of traumatized teeth optimally should be carried out as soon as possible. Since, majority of traumatic injuries occur at home, the ultimate prognosis of an avulsed tooth may depend on knowledge of the treatment procedure, possessed by his or her parents. The purpose of this study was therefore to evaluate the parental knowledge and attitude regarding the emergency management of avulsed teeth in children (in Davangere--both urban and rural, 1,000 each).

Unusual presentation of inverted impacted premolars as a result of dentigerous cyst: a case report.

A case of dentigerous cyst associated with upper right lateral incisor that had resulted in displacement of the canine, inverted impaction of both the premolars and dilaceration of apical 1/3 of central incisor is reported here.

Double facial and a lingual trace talon cusps: A case report.

Talon cusp is an uncommon odontogenic anomaly, presented as an accessory cusp like structure on the crown of an anterior tooth. Their presence may create diagnostic, esthetics, occlusal, pulpal and periodontal problems. This case report describes an unusual double facial talon cusp along with lingual trace talon on left maxillary central incisor.