Phenotypic Expression of Oral Fibroblasts Derived from Oral Submucous Fibrosis: An Assay through Cell Culture.

OBJECTIVE: The present study aimed to establish cell lines of fibroblast from human OSF tissues and their response to varying concentrations of arecoline. The various morphological forms of fibroblasts were identified to establish phenotypic change. MATERIALS AND METHOD: Fibroblast cell lines were obtained from control samples as well as from OSF cases. The cell lines were treated with 50/100/150/300/500 ug/ml of arecoline and morphology were determined. RESULTS: Three morphological forms were detected; F1 spindle, F2 epitheloid and the F3 stellate. The F3 to F1 ratio was higher in OSF. Arecoline at 50ug/ml was stimulatory and at 150ug/ml cytotoxic to the cell lines. CONCLUSION: Arecoline seems to enhance proliferation of the fibroblast at lower concentrations but cytotoxic at higher levels. This is probably due to the generation of new cell lines and response of the arecoline receptors indicating phenotypic change.

Scanning Electron Microscope Corroboration of Ameloglyphics - A New Tool in Forensic Odontology.

BACKGROUND: Human teeth resist decomposition to the maximum and has immense potential to serve as hard-tissue counterpart to dermatoglyphics in forensic odontology. Ameloglyphics is the science of recording and analyzing the tooth print. AIMS AND OBJECTIVES: To assess the scope of viability, reproducibility, and identification of enamel prints (akin to fingerprints) and their patterns as a tool for identification. To establish that expression of enamel prints is a direct result of the enamel rod configuration on the surface of the crown as detected by scanning electron microscope (SEM). MATERIALS AND METHODS: The teeth samples (n = 10) were first analyzed through (SEM) and the image of the arrangement of rods on the surface was captured. Enamel prints were registered in a standard procedure by virtue of ink transfer on a cellophane tape from etched tooth enamel surface of the same samples. These prints and SEM images were subjected to Rapid Sizer® image editing software to obtain a pattern (sketched outline image software). Patterns were identified manually. RESULTS: Reproducibility, specificity, and feasibility of the above procedure were determined. There appeared to be a high rate of reproducibility (98%-100%) and specificity (100%). The paraphernalia required as well as the technique entrenched were feasible. Furthermore, the SEM analysis established the viability and reliability. CONCLUSION: Ameloglyphics is a sensitive and reproducible scientific tool that can be utilized for the management, examination, and evaluation of dental evidence for identification at crime scene and disaster sites. Its importance vis-a-vis fingerprints cannot be understated, especially in view of the seeming indestructibility of the enamel.

Salivary 8-hydroxyguanosine levels in smokers and non-smokers with chronic periodontitis.

This case-controlled clinical trial was performed on the salivary 8-hydroxyguanosine (8-OHdG) levels in smokers and non-smokers with chronic periodontitis after non-surgical periodontal therapy. Subjects (N = 40) with periodontitis (smokers and non-smokers) and with clinically healthy conditions (smokers and non-smokers) were assigned to this study. At baseline, clinical periodontal parameters (plaque index, gingival index, pocket probing depth and clinical attachment levels) were evaluated. Saliva samples were obtained pre- and post-treatment to quantify the 8-OHdG levels using Elisa technique. Subjects diagnosed with chronic periodontitis with smoking habit (CPs) and non-smokers (CPns) received scaling and root planing. In clinically healthy subjects with smoking habit (CHs) and non-smokers (CHns), only oral hygiene tutoring was performed. All clinical measurements and salivary collection were repeated in a 3-month recall interval. Data were analyzed using Anova, Tukey post hoc test and Mann-Whitney 'U' tests (P < 0.05). At baseline, CPs and CPns groups showed significantly higher PI, GI, PD and CAL values than those of CHns and CHs (P < 0.001). Baseline salivary levels of 8-OHdG were significantly higher in CPs group (14.775 pg/mL) (P < 0.001) compared to the other groups. All clinical parameters in chronic periodontitis group improved at the 3rd month recall interval, however, with regards to 8-OHdG values, the CP smoker category still had a higher level compared to CP non-smoker. This study reflects an on-going periodontal destructive status in smokers and salivary 8-OHdG levels could be recognized as an oxidative biomarker for determining periodontal tissue destruction.

Effectiveness of a comprehensive educational programme for Accredited Social Health Activists (ASHAs) to identify individuals in the Udupi district with bleeding disorders: A community-based survey.

INTRODUCTION: The awareness and knowledge on bleeding disorders is generally poor among the rural population. Accredited Social Health Activists (ASHAs) serve as the facilitators between the rural community and the health care system. Training of ASHAs in screening of rural population for early identification of bleeding disorders can enable prompt referral, timely detection and management of bleeding disorders. AIM: The aim of the study was to evaluate the effectiveness of an ASHA training programme for identification of suspected bleeding disorder cases. METHODS: A population-based, cross-sectional survey was implemented by 586 Accredited Social Health Activists (ASHAs) in rural Udupi district, who underwent a structured training programme on identification of bleeding disorders. A survey record book with a screening tool on assessment of bleeding symptoms was given to each ASHA. The screening tool consisted of symptoms related to bleeding disorders and family history of bleeding disorders. Using the screening tool, ASHAs carried out a door-to-door survey. After screening, those who reported with bleeding symptoms were referred by the ASHAs to the investigator, who conducted further assessment. A detailed bleeding history was documented and bleeding symptom assessment was carried out using bleeding assessment tool (BAT) at the haemophilia treatment centre. Further coagulation assessments were carried out as per the treatment centre protocol. This paper highlights the evaluation of an ASHA training programme on identification of individuals with bleeding symptoms in the rural population. RESULTS: A total of 586 trained ASHAs surveyed a population of 318 214 in rural Udupi district. Out of the 124 cases reported by ASHAs, 29 bleeding disorder cases were identified; haemophilia (A and B) was the most commonly found bleeding disorder 22 (75.8%), followed by von Willebrand disease (vWD) 3 (10.3%) and 4 (13.8%) immune-mediated thrombocytopenic purpura (ITP), with an overall prevalence of 2.2/10 000 population. CONCLUSION: Training ASHA health care workers, who are the most important link between the community and health services, resulted in increased awareness among the public for the early detection of bleeding disorders.

Hydatid cyst of the buccal mucosa: An unusual presentation.

Hydatid cyst is a parasitic cyst caused by the tapeworm Echinococcus that occurs primarily in sheep grazing areas worldwide. It is a chronic disease, and the cysts can be localized in unusual anatomical and geographic locations. It is known to affect the head and neck region. Patients must undergo a thorough systemic investigation as 20-30% show multiorgan involvement. We report a case of hydatid cyst occurring in the buccal mucosa of a 45- year -old male presenting as a small asymptomatic lump and emphasize on its rarity and diagnostic issues.

Psammous desmo-osteoblastoma with concomitant aneurysmal bone cyst of mandible.

Juvenile psammomatoid ossifying fibroma is a gradually progressive, aggressive extragnathic craniofacial tumor of bone. Due to its complex histogenesis, biological behavior, histology, and classification, its nomenclature has always been the focus of debate among pathologists. Based on the clinical behavior and histology, the term psammous desmo-osteoblastoma (PDO) is an apt expression for this lesion. Immunohistochemical investigation with anti-osteonectin shows positivity for spindle cells whereas psammoma bodies are negative. These results shore up the hypothesis of osteogenic differentiation of the undifferentiated mesenchymal cells of the periodontal ligament that may be responsible for the aggressive behavior of the lesion. Aneurysmal bone cysts (ABCs) are known to be secondarily associated with primary osseous neoplasms like ossifying fibroma, giant cell granuloma, etc. We report a rare case of PDO with concomitant ABC in the mandible of a 30-year-old male patient. The present lesion had recurred at the same site of an osteolytic lesion diagnosed 7 years ago as a benign fibro-osseous lesion and treated by conservative surgical curettage. The histological presentation substantiated by special stains and immunohistochemistry point to the diagnosis of psammous desmo-osteoblastoma with a concomitant ABC. Review of the literature revealed the presentation to be rare with very few cases reported till date.

A multicenter prospective hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children less than five years of age in India.

BACKGROUND: Rotavirus is the leading cause of severe, dehydrating diarrhea in children aged <5 years globally, with an estimated 25 million outpatient visits and 2 million hospitalizations attributable to rotavirus infections each year. The aim of this hospital-based surveillance was to summarize the local epidemiological and virological features of rotavirus and to estimate the disease burden in the population under surveillance in India. METHODS: During the 16 months surveillance period from April 2011 through July 2012, a total of 4711 children under the age of 5 years were admitted with acute diarrhea at 12 medical centers attached to medical schools throughout India. Stool samples were randomly collected from 2051 (43.5%) subjects and were analyzed for rotavirus positivity using commercial enzyme immunoassay kit (Premier Rotaclone Qualitative Elisa) at the respective study centers. Rotavirus positive samples were genotyped for VP7 and VP4 by reverse-transcription polymerase chain reaction (RT-PCR) at a central laboratory. RESULTS: During the study period, maximum number of rotavirus related hospitalizations were reported from December 2011 through February 2012. Out of the 2051 stool samples tested for rotavirus, overall 541 (26.4%) samples were positive for rotavirus VP6 antigen in stool. The highest positivity was observed in the month of December, 2011 (52.5%) and lowest in the month of May, 2011 (10.3%). We found that majority of the rotavirus positive cases (69.7%) were in children <24 months of age. The most common genotypes reported were G1 (38%), G2 (18%), G9 (18%), G12 (9%) and mixed strains (17%). CONCLUSIONS: The results of this study confirm the significant burden of acute rotavirus gastroenteritis as a cause of hospitalizations in under five children in India.

Retrospective surveillance for intussusception in children aged less than five years at two tertiary care centers in India.

BACKGROUND: A rotavirus vaccine could soon become part of India's national immunization program. However the occurrence of intussusception due to rotavirus vaccine is a potential safety concern. This surveillance aimed at the collection of baseline data on childhood intussusception which would facilitate the monitoring of intussusception cases after the introduction of rotavirus vaccines. METHODS: We retrospectively reviewed medical records of confirmed intussusception cases in children under the age of five, treated during 2007-2012 at two tertiary care hospitals attached to medical schools in India. Demographic, clinical, diagnostic and treatment practices data were obtained from hospital records. RESULTS: Over a five to six year observation period, we identified 187 confirmed cases of intussusception, of which 75% were males. The median age of intussusception was 8 months, and we observed a possible trend in the distribution of cases with the highest number of cases being reported in the month of April and lowest in the month of October. The most common diagnostic methods used were ultrasonography and abdominal radiography with most cases being treated surgically (71%). The median length of hospital stay was 8 days (range 1-40) and mean was 10.2 days. Records of any fatality due to intussusception were not found during the review of the records. CONCLUSIONS: This analysis provides an estimate of the baseline data of childhood intussusception prior to the introduction of the rotavirus vaccination as a part of routine immunization in India. A prospective surveillance system using a standardized case definition is needed in order to better examine the incidence of intussusception in developing countries.

A fatal case of rapid gingival enlargement: Case report with brief review.

Myeloid sarcoma (MS) is a rare extramedullary tumor composed of primitive granulocytic cells. These lesions are commonly associated with other hematologic disorders such as myeloid leukemia and other myeloproliferative neoplasms. Although extremely rare in the oral cavity, this lesion was reported in gingiva, palate, buccal mucosa and extraction sockets. MS is an aggressive lesion associated with poor prognosis. Early identification and prompt treatment holds the key for increasing the disease-free period in these patients. In this context, we report a rare and aggressive case of MS, which ran a fatal course in a 45-year-old female patient.

Biochemical markers in oral submucous fibrosis: A review and update.

Oral submucous fibrosis (OSMF) is a potentially malignant oral condition effectively linked to the causative habit of chewing areca nut. Since its first description in the 1950s, numerous epidemiological, biochemical, histological, and genetic studies have been reported. While most studies point out to the cause and effect of areca nut, co-additive factors are also implicated in the progression and malignant transformation of this condition. Biochemical investigations have concentrated on outlining such changes in the blood, serum or tissues of these patients and have given insights on the possible pathogenesis of OSMF. This article attempts to compile details of biochemical investigations in OSMF and summarize and infer on the findings.

Laparoscopic vertical sleeve gastrectomy after open gastric banding in a patient with situs inversus totalis.

While several equivalent alternatives are available in the bariatric algorithm, more recently the laparoscopic sleeve gastrectomy (SG) has been gaining traction as an effective means of weight loss in patients with morbid obesity. We present the case of a 39-year-old woman with situs inversus totalis, who was taken to the operating room for laparoscopic SG. The patient had previously undergone a failed open gastric banding procedure 20 months earlier. Awareness of the inherited condition before performing the operation allows for advanced planning and preparation. Subsequent modifications to the standard trocar placement help make the procedure more technically feasible. To our knowledge, this is the first published report of a laparoscopic SG after open gastric banding in a patient with situs inversus totalis. After encountering the initial disorientation, we believe experienced laparoscopic surgeons can perform this procedure successfully and safely.

Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon.

Compression and absolute stability are important in the management of intra-articular fractures. We compared tension band wiring with plate fixation for the treatment of fractures of the olecranon by measuring compression within the fracture. Identical transverse fractures were created in models of the ulna. Tension band wires were applied to ten fractures and ten were fixed with Acumed plates. Compression was measured using a Tekscan force transducer within the fracture gap. Dynamic testing was carried out by reproducing cyclical contraction of the triceps of 20 N and of the brachialis of 10 N. Both methods were tested on each sample. Paired t-tests compared overall compression and compression at the articular side of the fracture. The mean compression for plating was 819 N (sd 602, 95% confidence interval (CI)) and for tension band wiring was 77 N (sd 19, 95% CI) (p = 0.039). The mean compression on the articular side of the fracture for plating was 343 N (sd 276, 95% CI) and for tension band wiring was 1 N (sd 2, 95% CI) (p = 0.038). During simulated movements, the mean compression was reduced in both groups, with tension band wiring at -14 N (sd 7) and for plating -173 N (sd 32). No increase in compression on the articular side was detected in the tension band wiring group. Pre-contoured plates provide significantly greater compression than tension bands in the treatment of transverse fractures of the olecranon, both over the whole fracture and specifically at the articular side of the fracture. In tension band wiring the overall compression was reduced and articular compression remained negligible during simulated contraction of the triceps, challenging the tension band principle.

Superolateral dislocation of the mandibular condyle not associated with fracture: a case report.

BACKGROUND: Superolateral dislocation is rarely encountered in clinical practice. It is usually associated with fracture of the contralateral mandibular body or zygoma. The occurance of type II superolateral dislocation of the condyle without associated fracture is very rare and only a few cases are reported in literature. METHODS: We present a case report in which the patient had a type II superolateral dislocation of the mandibular condyle which is not associated with any fracture. The condyle was hooked laterally above the zygomatic arch. The fracture was reduced surgically and good results were obtained. CONCLUSION: We thereby would like to ascertain the fact that a type II superolateral dislocation of the mandibular condyle can occur without any associated fractures.

Health and social problems of the elderly: a cross-sectional study in udupi taluk, karnataka.

BACKGROUND: Change in socio-economic status and various health problems adversely affect an individual's way of life during old age. OBJECTIVES: To study the health and social problems of the elderly and their attitude towards life. MATERIALS AND METHODS: Descriptive study carried out in the Field practice area of the Department of Community Medicine in South India. A total of 213 elderly patients (60 years old and above) who attended the outreach clinics were interviewed using a pre-tested schedule. Findings were described in terms of proportions and percentages to study the socio-economic status of the samples and its correlation to social problems. RESULTS: Around 73% of the patients belonged to the age group of 60-69 years old. Nearly half of the respondents were illiterate. Around 48% felt they were not happy in life. A majority of them had health problems such as hypertension followed by arthritis, diabetes, asthma, cataract, and anemia. About 68% of the patients said that the attitude of people towards the elderly was that of neglect. CONCLUSIONS: The results of the study showed that there is a need for geriatric counseling centers that can take care of their physical and psychological needs. The stringent rules for eligibility to social security schemes should be made more flexible to cover a larger population.

Effectiveness of reproductive health education among rural adolescent girls: a school based intervention study in Udupi Taluk, Karnataka.

BACKGROUND: Adolescence is the most important and sensitive period of one's life [1] . According to the World Health Organization (WHO) Expert Committee, adolescence is defined as the period between 10 and 19 years, the second decade of life. OBJECTIVE: To determine the effectiveness of an educational intervention program on knowledge of reproductive health among adolescent girls. SETTINGS AND DESIGN: This educational intervention study was carried out over a period of one year. A total of 791 rural girls in the age group 16-19 years were randomly selected from coastal villages in Udupi District, Karnataka. MATERIALS AND METHODS: Adolescent girls were educated regarding reproductive health and their awareness levels were evaluated immediately following intervention. STATISTICAL ANALYSIS: Data was tabulated and analyzed using SPSS version 11.0 for Windows. Findings were described in terms of proportions and percentages. Chi square test was used to test the effect of the intervention. RESULTS: A significant increase in overall knowledge after the intervention (from 14.4 to 68%, P < 0.01) was observed regarding contraception. Knowledge regarding ovulation, first sign of pregnancy and fertilization improved by 37.2% (95% CI = (35.2, 39.2), P < 0.001). Knowledge regarding the importance of diet during pregnancy improved from 66 to 95% following the intervention. CONCLUSION: This study clearly showed that an educational intervention program can bring about a desirable change in knowledge among adolescent girls regarding reproductive health.

Downstaging for cervical cancer: a community-based study in the rural areas of Udupi district, Karnataka, India.

The objective of this study is to determine the feasibility of utilizing trained auxiliary nurse midwives (ANMs) in downstaging for cancer cervix in a rural area. The study population included all married women in the age group of 35-59 years in two villages of the field practice area. It was a cross-sectional study. Two ANMs were trained in history taking, visual inspection of the cervix, using of speculum and collecting Papanicolaou smears. After training, they made home visits and identified women with gynaecological symptoms suggestive of cervical cancer. These women were asked to report to Rural Maternity and Child Welfare whom homes where the ANMs did a visual inspection of the cervix and made a cervical smear. A total of 1402 women were registered of the ANMs could identify 368 women (26%) with symptoms. Only 192 (52.2%) of these women reported for examination. Chronic cervicitis accounted for the largest proportion of the cases (44.8%). In all, three cases were diagnosed as suspected cases of cancer cervix. On cytology, three cases (1.5%) turned out to be malignant. When clinical findings of the ANM were compared with results of cytological examination, a high degree of sensitivity (78.4%) and positive predictive value (97.1%) were observed in diagnosing abnormal cytological findings. However, the sensitivity for detecting specific conditions was generally low. Sensitivity for detecting erosion was 45%, for chronic cervicitis 30%, and malignancies were totally missed. In conclusion, this study clearly shows that ANMs, if trained, would be capable of identifying symptomatic women, differentiating a normal cervix from an abnormal one and taking an adequate smear for cytological examination.

Acceptability and effectiveness of a breast health awareness programme for rural women in India.

BACKGROUND: Breast cancer being one of the leading cancers among women in developing countries, prevention or identification of the disease at an early stage is of paramount importance in saving as well as improving the quality of life. Breast health awareness appears to be a pragmatic method for this. OBJECTIVE: To determine the acceptability and effectiveness of an educational intervention programme on breast health awareness for rural women by trained female health workers. SETTINGS AND DESIGN: Community based non-randomised educational intervention study carried out over a period of 1 year. Three hundred and sixty rural women in the age group 30--59 years were randomly selected (and age-wise stratified), from a coastal village in Southern India. METHODS: Women were educated on breast health and breast self-examination by specifically trained health workers and their awareness and proficiency levels were evaluated at the end of 1 and 3 months post-intervention. STATISTICAL ANALYSIS: This was done using the Statistical Package for Social Sciences Version 10. RESULTS: Following the educational intervention, a significant increase in overall awareness regarding breast cancer (z=-15.807; P< 0.001) as well as in the performance of self-examination of the breast 321/342 (93%) was observed. Forgetfulness or being too busy appeared to be the two most frequently perceived barriers. CONCLUSION: This study clearly shows that a community oriented educational intervention programme emphasizing on proper technique can bring about the desirable behavioural change among women.