Effectiveness of Platelet-Rich Fibrin with Decalcified Freeze-Dried Bone Allograft Compared to Decalcified Freeze-Dried Bone Allograft Alone in Mandibular Grade-II Furcation Defects: A Quasi-Experimental Study

ABSTRACT Objective: To assess the effectiveness of platelet-rich fibrin (PRF) with decalcified freeze-dried bone allograft (DFDBA) compared to DFDBA alone in mandibular grade-II furcation defects. Material and Methods: A quasi-experimental study was conducted on nine patients with chronic periodontitis, each having two almost identical mandibular grade II furcation defects. Test sites (left mandibular first molars) were treated with open flap debridement (OFD), DFDBA, and PRF, whereas control sites (right mandibular first molars) received OFD and DFDBA alone. Clinical parameters (plaque index (PI), gingival index (GI), vertical clinical attachment level (VCAL) and horizontal clinical attachment level (HCAL) into the furcation defect) and radiographic measurements (mean alveolar bone defect) were done at baseline and after six months postoperatively. Results: The gain in relative horizontal clinical attachment level (RHCAL) in the test sites was 2.94±0.52 mm compared to 1.33±0.35 mm in control sites (p=0.01). Improvement in mean alveolar bone defect (MABD) (was 1.21±0.5 mm2 at test sites compared to 1.15±0.7 mm2 at control sites) probing pocket depth (PPD), recession, relative vertical attachment level (RVCAL), and percentage of bone fill was found in the test sites compared to control, which statistically insignificant. Conclusion: The test sites had better outcomes than control sites, which was significant for the parameter RHCAL. Therefore, combining the biological benefits of autologous PRF with DFDBA is an efficient and economical treatment modality for the management of mandibular grade II furcation defects.

Detection of Genetic Alterations in Oral Squamous Cell Carcinoma Using Multiplex LigationDependent Probe Amplification (MLPA)

@#Deletions and amplifications of genes often occur during multistep progression from oral precancer, seen as oral epithelial dysplasia (OED) to cancerous stage. These genetic alterations could be used as markers to aid in detection of oral squamous cell carcinomas (OSCC). This study explored the use of multiplex ligation-dependent probe amplification (MLPA) technique in detecting OSCC and OED specific genetic alterations. MLPA was used to detect gains and losses of 106 genes in DNA extracted from frozen tissue samples of 10 OSCC and 10 noncancer patients. Two biopsies of OED were analyzed to explore the alterations in oral potentially malignant disorders. There were significant differences (p<0.001) in the number of alterations in OSCC and dysplasia compared to non-cancer samples respectively. The most frequently altered genes in OSCC were PTP4A3, RECQL4, ATM, and KLK3 (60%). Five genes (MYC, SLA, TNFRSF1A, MESDC1, MIF) were altered in 50% of OSCC samples. These nine genes were specific to OSCC samples (p<0.05). Some genes, including MYB, MET, CASP2, SLA and PTEN occurred in 50% of OED samples. MLPA was able to detect genetic alterations, that are present only in the OSCC samples and showed potential to be used as an adjunctive tool in early diagnosis of OSCC.

PLATELET CONCENTRATES FOR PERIODONTAL REGENERATION

@#Platelet concentrates are derivatives of blood that aid in haemostasis and wound healing after periodontal regenerative procedures. Its ability to act as a natural scaffold of growth factors has gained significance in many surgical procedures. This narrative review discusses the different platelet concentrates, their centrifugation protocols, advantages and disadvantages and their application in periodontal regenerative procedures. An electronic search of PubMed or MEDLINE was conducted for relevant material from the published literature up to 2020. The key words looked for were “Platelet concentrates, Platelet rich plasma, Platelet rich fibrin and periodontal regeneration.” We have used the filters comparative human studies, animal studies, randomized controlled trials, case reports and systematic reviews. The searches were limited to articles in English language and articles describing platelet concentrates and its relation to periodontal regeneration were collected and used to prepare a concise review.

Micro RNAs In Periodontal Disease – A Review

@#microRNAs (miRNAs) constitute a family of small, non-coding RNA molecules that regulate gene expression and protein expression. microRNAs have influence on a broad range of physiologic and pathologic conditions. They are also considered as promising biomarkers especially when they are secreted extracellularly. In the inflammatory pathways, they dysregulate the molecular processes and contribute to the development of chronic inflammatory diseases including periodontitis. In this review, we provide an overview of miRNA characteristics, biogenesis, mechanisms of action and profiling methods. In addition, the role of miRNAs in the pathobiology of periodontitis, especially those pertaining to the cellular and molecular pathways of inflammation has been considered to enhance our understanding of the pathobiology of periodontitis.

The National Medical Commission: More of the same

The Cabinet chaired by the Prime Minister has accepted six amendments to the National Medical Commission Bill suggested by the Department-related Parliamentary Standing Committee (1). These amendments are: the proposed National Licentiate Examination has been replaced by a countrywide final MBBS examination called the National Exit Test (NEXT); the bridge course to train practitioners from AYUSH (Ayurveda, Unani, Siddha and Homeopathy) in modern medicine has been removed, and it has been left to individual states to take a decision about this; the percentage of seats in private medical training institutions under fee regulation has been increased from 40% to 50%; the number of nominees from the states and Union territories who are members of the Commission has been increased from three to six; the penalties for non-compliance with educational norms for colleges has been modified; and the punishment for practising modern medicine without qualification has been made imprisonment up to one year and a fine of Rs 5 lakh.

Next-generation sequencing analysis reveals high bacterial diversity in wild venomous and non-venomous snakes from India

The oral cavities of snakes are replete with various types of bacterial flora. Culture-dependent studies suggest that some of the bacterial species are responsible for secondary bacterial infection associated with snakebite. A complete profile of the ophidian oral bacterial community has been unreported until now. Therefore, in the present study, we determined the complete bacterial compositions in the oral cavity of some snakes from India. Methods: Total DNA was isolated from oral swabs collected from three wild snake species (Indian Cobra, King Cobra and Indian Python). Next, the DNA was subjected to PCR amplification of microbial 16S rRNA gene using V3-region-specific primers. The amplicons were used for preparation of DNA libraries that were sequenced on an Illumina MiSeq platform. Results: The cluster-based taxonomy analysis revealed that Proteobacteria and Actinobacteria were the most predominant phyla present in the oral cavities of snakes. This result indicates that snakes show more similarities to birds than mammals as to their oral bacterial communities. Furthermore, our study reports all the unique and common bacterial species (total: 147) found among the oral microbes of snakes studied, while the majority of commonly abundant species were pathogens or opportunistic pathogens to humans. A wide difference in ophidian oral bacterial flora suggests variation by individual, species and geographical region. Conclusion: The present study would provide a foundation for further research on snakes to recognize the potential drugs/antibiotics for the different infectious diseases.(AU)

Epstein–Barr virus infection in B-cell Non-Hodgkin’s Lymphomas of the Oral and Maxillofacial Region: Is there any evidence?

Introduction: Epstein–Barr virus (EBV) might be an aetiological agent involved in the pathogenesis of certain Non-Hodgkin’s Lymphomas (NHLs). EBV infection has been diagnosed by serologic testing within the tumour biopsies of patients with NHL. However, the association between EBV and NHL is inconsistent with a preference for certain anatomic sites, histologic subtypes and immunosuppressed patients. The objective of this study was to characterise the B-cell NHLs of the oral cavity and maxillofacial region using histological and immunophenotypical techniques and to determine its association with EBV infection. Materials and Methods: This was a descriptive cross-sectional study that included 14 cases of B-cell NHLs of the oral cavity and maxillofacial region. The haematopoietic and lymphoid tissue tumours classification of WHO was used to categorize the cases. In-situ hybridisation for EBV–encoded RNA was performed to confirm the EBV infection. Results: The average age of the patients included in the study was found to be 48.8 ± 23 years with a higher female to male ratio (1.3:1). Our study suggested that diffuse large B-cell lymphomas (DLBCLs) and Burkitt’s lymphomas (BLs) constitute the predominant subtypes of lymphomas affecting the oral cavity and maxillofacial regions. Conclusion: The findings from our study support the view that at least a relatively smaller proportion of B-cell NHLs that occur in the oral cavity and maxillofacial region do not have a pathogenic association with EBV.

Medical education in India – the way forward.

In 1956, the four-year-old republic of India replaced the colonial Indian Medical Council with the Medical Council of India (MCI). This institution was meant to guide the young republic in establishing a modern system of medical education and developing the human resources to provide the most appropriate medical care to all citizens.

The Allied and Healthcare Professional's Central Council Bill, 2015: more of the same

he Medical Council of India (MCI) is a statutory body established in February 1934 under the Indian Medical Act, 1933. This act was repealed in 1956 and replaced by the Indian Medical Council Act, 1956.

In vitro comparative evaluation of the physical and mechanical properties of two soft-liners coated with different types of coatings

Aim: To evaluate the changes on the physical and mechanical properties of acrylic and silicone based soft liners after applying four different types of coatings

Methods: A total of 60 samples were prepared and divided into two major groups viz. Group A-Exact-On [30 samples] and Molloplast-B [30 samples]. Group A and B were further subdivided into 5 subgroups I, II, III, IV and V containing 6 specimens each. The samples were coated with four different types of coatings and were compared to the uncoated control group [subgroupl]. Main composition of two types of Monopoly were chemically activated methylmethacrylate monomer, clear methylmethacrylate polymer, heat activated methylmethacrylate monomer. Two new types of coatings were made with n-butyl cyanoacrylate. These two coatings were never tried before in any literature review. The coated samples were tested for Hardness, Permanent deformation, Tensile strength, Water absorption determination and the coated surfaces were observed under SEM and compared with the uncoated control group

Results: Molloplast-B, a silicone based had longer shelf life but a coated acrylic based liner was seen to be equally good. Cyanoacrylate monomer coating and self cure monopoly coating were superior to other coatings. All results were statistically analyzed by 2-way ANOVA. The mean values for hardness ranged from 24.16 to 29.33 Shore A for Group A and 41.50 to 42 Shore A for Group B. Values of permanent deformation ranged from 1.01 to 0.93% for the Exact-On [Group A] and 0.158 to 0.140% in coated Molloplast-B samples [Group B]. Mean values of Tensile strength ranged from 5kg/cm[2] to 6.00kg/cm[2] in Group A and 16.33 kg/cm[2] to 17.67kg/cm[2] in Group B. It was observed that among the coatings Cyanoacrylate Monopoly coating was more efficient in preventing water absorption and leaching followed by Cyanoacrylate Monomer coating

Conclusion: None of the coatings affected the physical properties of tissue conditioners. All coatings prevented water absorption from tissue conditioner and prolonged the life of tissue conditioner

The Medical Council of India – change necessary, apprehensions persist.

The Government of India superseded the Medical Council of India (MCI) with effect from May 15, 2010 by an amendment to the Indian Medical Council Act, 1956. The supersession followed reports of financial irregularities and corruption in the Council. A board of governors was put in place. By two further amendments in 2011 and 2012, the powers of the MCI continued to be exercised by reconstituted boards of governors. The term of the current board of governors expired on May 14, 2013. An extension of 180 days has been granted and, therefore, the Central Government should reconstitute the MCI by November 10, 2013 at the latest. On March 19, 2013, the government introduced a bill, The Indian Medical Council (Amendment) Bill, 2013, for the purpose . However, the government has inserted an escape clause that would allow it not to adhere to the time schedule. This is Section 3AA, which states, “The Central Government shall, as soon as possible [italics added], after the commencement of the Indian Medical Council (Amendment) Act 2013, by notification in The Gazette of India, reconstitute the Council…..: provided that the Board of Governors constituted under sub-section of Section 3A shall continue to exercise the powers and perform the functions of the Council till the new Council is reconstituted.” So, do not hold your breath. With Parliament’s recent record of performance, it will be surprising if the Bill gets passed in the monsoon session.

Book Review : Bad pharma.

I had read Dr Ben Goldacre’s earlier book Bad Science, an excellent description of scientific methods, their use and misuse; but had hesitated to buy Bad Pharma when I first saw it in bookshops.

How ‘informed’ is informed consent? Findings from a study in South India.

A qualitative study using in-depth interviews was carried out among patients and doctors working in a private hospital in Tamil Nadu, to understand perceptions of informed consent. Audio-recorded interviews were transcribed verbatim and a framework analytical approach was used in analysis. Emergent themes ranged from perceptions on informed consent, and discussing health concerns and decision making, to information provided by and expectations from doctors, and suggestions for improvement. Most patients were unfamiliar with the kind of information provided in the informed consent process; a few felt that the information was inadequate. Decision making about surgery was left mostly to the doctor. Poor literacy in patients was seen as a barrier to effective communication by doctors.

No dependable alternative to MCQs.

The editorial by Drs. Prabha Chandra and Sowmyashree revisits the vexed problem of the best method of selection of post-graduate medical students. The problems they cite are true of the selection process for undergraduate students as well. There is no doubt that the recommendations in the Vision 2015 document of the Medical Council of India are unlikely to improve the situation. Unfortunately, this is true also of the recommendations made in the editorial.

Institutional ethics committees: critical gaps.

The guidelines issued in 2006 by the Indian Council for Medical Research in India , for the formation and conduct of clinical trials in India, are still the benchmark by which the conduct of such trials is evaluated. Unfortunately, these guidelines have not yet got the force of law, since the bill is still pending in Parliament. An important section of the guidelines pertains to the constitution and conduct of the committees which should examine, permit and monitor clinical research in India. Information on how well the committees are functioning is not easily available. Personal observation and conversations with members of ethics committees in other institutions have revealed certain serious lacunae, which have the potential to entirely subvert the purpose of these committees.

Medical Council of India and the Indian Medical Association: uneasy relations.

The Medical Council of India (MCI), in a rare act, suspended the licences of the president and secretary of the Indian Medical Association (IMA) for six months, on the grounds that they had performed an unethical act in endorsing products of PepsiCo and Dabur. The MCI’s action followed a one-person campaign by Dr Babu KV, starting in June 2008, first to the MCI, then to the government of India and the National Human Rights Commision..The Delhi High Court has stayed the action of the MCI. The deal was worth Rs.2.25 crore and he endorsements were to continue from 2008 to 2011. There is no doubt that the IMA is in contravention of the code of thics prescribed for doctors by the MCI, and, therefore, action is in order. The IMA, instead of appealing against the quantum of punishment, has taken an adversarial stance on the verdict itself and obtained a stay on the order.