A relationship between salivary flow rates and Candida counts in patients with xerostomia.

CONTEXT: Most of the adult population is colonized by Candida in their oral cavity. The process of colonization depends on several factors, including the interaction between Candida and salivary proteins. Therefore, salivary gland hypofunction may alter the oral microbiota and increase the risk for opportunistic infections, such as candidiasis. Hence, it is necessary to evaluate the relationship between salivary flow rates (SFRs) and Candida colony counts in the saliva of patients with xerostomia. AIMS: This study aims to determine and evaluate the relationship between SFRs and Candida colony forming units (CFUs) in patients with xerostomia. SETTINGS AND DESIGN: This study was a descriptive study. SUBJECTS AND METHODS: The study participants were taken from the patients attending outpatient department in a private dental college. Fifty patients, who reported xerostomia in a questionnaire of the symptoms of xerostomia, were selected. Chewing stimulated whole saliva samples were collected from them and their SFRs were assessed. Saliva samples were inoculated in the Sabouraud dextrose agar culture media for 24-48 h, and Candida CFUs were counted. STATISTICAL ANALYSIS USED: Chi-squared test was used to analyze the data. RESULTS: There was a significant inverse relationship between salivary flow and candida CFUs count when patients with high colony counts were analyzed (cutoff point of 400 or greater CFU/mL). Females had less SFR than males. Most of the patients who had hyposalivation were taking medication for the underlying systemic diseases. Candida albicans was the most frequent species. CONCLUSIONS: There was a significantly negative correlation between SFRs and Candida CFUs in the patients with xerostomia.

Comparison of chemiluminescence and toluidine blue in the diagnosis of dysplasia in leukoplakia: a cross-sectional study.

AIMS: The early diagnosis and treatment of oral cancer at a potentially-malignant stage would reduce morbidity and improve the survival rates and quality of life of patients. Leukoplakia is the most common potentially-malignant disorder. Clinical examination alone cannot differentiate between dysplastic and non-dysplastic leukoplakia. Chemiluminescence and toluidine blue are adjuncts to conventional examination for the early detection of dysplasia. The present study was conducted to compare the efficacies of chemiluminescence and toluidine blue for the diagnosis of dysplasia in leukoplakia. METHODS: One hundred patients with leukoplakia were subjected to conventional oral examination, chemiluminescent examination with ViziLite and toluidine blue test, followed by histopathological confirmation of dysplasia. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of chemiluminescence was 84.84%, 41.17%, 73.68%, 58.33%, and 70%, respectively. For toluidine blue it was 42.4%, 88.23%, 87.50%, 44.11%, and 58% respectively. CONCLUSIONS: Both the techniques have adjunctive utility in the diagnosis of dysplasia in leukoplakia, but toluidine blue was more effective in identifying the more severe grades of dysplasia, and thus it effectively discriminated high-risk from low-risk lesions.

Psychological factors and personality traits associated with patients in chronic foot and ankle pain.

BACKGROUND: The impact of psychosocial factors and personality traits in chronic pain is well established. However, there has been limited literature analyzing the influence of psychological issues in chronic foot and ankle pain. The aim of our study was to identify the association of certain psychosocial factors and personality traits in individuals with chronic painful foot and ankle disorders. METHODS: Patients with chronic foot and ankle pain were recruited from the specialist foot and ankle clinic. The Eysenck Personality Questionnaire-Revised (EPQ-R), Dysfunctional Attitude Scale (DAS), and Hospital Anxiety Depression (HAD) scale were administered in the form of questionnaires. An age- and sex-matched cohort of healthy volunteers served as the control group. Sample size was determined after power calculation, and a total of 90 participants were recruited with informed consent with 45 participants in each arm. Results were analyzed and statistical analyses were performed using SPSS. RESULTS: Patients with chronic foot and ankle pain had significantly higher neuroticism scores than the control group (P < .05). The study also revealed greater prevalence of anxiety and depression in patients with chronic pain (P < .05). CONCLUSION: The study showed a significant association of anxiety, depression, and neuroticism in patients presenting with chronic foot and ankle pain. Clinicians should recognize the influence of these specific psychological issues to provide a more holistic approach to the clinical problem. LEVEL OF EVIDENCE: Level III, case control study.

Necrotizing sialometaplasia of palate: a case report.

Necrotizing sialometaplasia (NS) which mimics malignancy both clinically and histopathologically is an uncommon benign, self-limiting inflammatory disease of the mucus-secreting minor salivary glands. The lesion is believed to be the result of vascular ischemia that may be initiated by trauma. Till date, the diagnosis of NS remains a challenge. This report demonstrates a case of NS in a 73-year-old male patient who presented with an ulcerative lesion in his palate. He had a history of local trauma and was long-term user of salbutamol inhaler. An incisional biopsy was carried out and the diagnosis was established through history, clinical examination, histopathology using Hematoxylin and Eosin stain. The patient was given symptomatic treatment and the lesion healed in about 7 weeks.

An unusual case of sporadic Creutzfeldt-Jakob disease (CJD).

A 49-year-old healthy white British female, not previously known to psychiatric services, presented with an acute onset of florid psychotic symptoms. Her symptoms included visual, auditory and tactile hallucinations as well as persecutory delusions. She was started on antipsychotic medication; however, her psychotic symptoms did not improve significantly in the first 3 months. Her blood tests were normal. Lumbar puncture was performed which was positive for protein 14-3-3. A computed tomography scan of the brain showed generalised atrophic changes. The history of early visual hallucinations, rapid cognitive decline and positive 14-3-3 result was in keeping with the Heidenhain variant of sporadic Creutzfeldt-Jakob disease (sCJD). Despite a short life expectancy as reported in literature, our patient, who was diagnosed with sCJD more than two-and-a-half years ago, is still alive. We therefore believe this is an important finding to report.

Reversible hyponatraemia with venlafaxine in a young patient.

A 28-year-old woman with a depressive episode developed hyponatraemia (126 mmol/l), in the absence of hypovolaemia, oedema, or diuretic use, 2 weeks after starting treatment with the antidepressant venlafaxine. Full blood count, potassium, urea, creatinine, thyroid function test, liver function test, amylase, serum cortisol, and glucose were all normal. A repeat blood test 3 days later revealed a further reduction in the sodium concentration to 123 mmol/l. The patient did not have any signs or symptoms of physical disorder secondary to hyponatraemia on this occasion. Her serum sodium reached normal values 2 weeks after stopping treatment with venlafaxine. Hyponatraemia secondary to venlafaxine has been reported in the older population but not in young people. We therefore believe this is an important finding.