Expression of anti - Apoptotic survivin in odontogenic keratocyst, adenomatoid odontogenic tumor and ameloblastoma.

Background: The process of odontogenesis is complex involving epithelial-mesenchymal interactions, along with the molecular signalling pathways triggering the initiating process. The triggering factors and cells precisely involved in the pathogenesis of odontogenic cysts and tumors are unknown. There is a vast array of biomarkers used to stain different sites, thereby helpful in diagnosing and evaluating the prognosis of these cysts and tumors. In the following study, Anti Apoptotic survivin expression patterns were assessed quantitatively in 48 samples (12 each) of Reduced Enamel Epithelium, Adenomatoid Odontogenic Tumor, Odontogenic Keratocyst and Ameloblastoma. Aim: The Aim of this study is to assess the anti-apoptotic survivin expression in Reduced Enamel Epithelium, Adenomatoid odontogenic tumour, Odontogenic Keratocyst and Ameloblastoma. Materials and Methods: The present study is carried out with 12 samples in each group. Routine hematoxylin and eosin staining was performed for confirmatory diagnosis. Later Immunohistochemistry was performed using survivin antibody. Survivin protein expression was analyzed using the parameters like location, intensity, percentage of cells positivity with survivin protein and extent of staining. With the help of Olympus BX 43 microscope, with ProgRes microscope camera, the 48 slides obtained were examined. The region of interest was selected in each slide and number of cells positively stained was counted. Data was analyzed using SPSS software version 23. Descriptive for scale data, results were analysed by using ANOVA with Chi-square test for intergroup comparison. Results: The results showed significant P value <0.05. Expression of survivin was highest in Ameloblastoma, followed by Odontogenic keratocyst, Adenomatoid odontogenic tumor, and Reduced Enamel Epithelium. Conclusion: Survivin was involved in the inhibition of apoptosis as well as the detailed understanding of the biological behaviour of odontogenic cysts and tumours, thereby increasing therapeutic approaches.

Assessment of the quality of randomized controlled trials in surgery using Jadad score: Where do we stand?

Introduction: Quality assessment of randomized controlled trials (RCTs) is important to prevent clinical application of erroneous results. Materials and Methods: This was an assessment of published RCTs in surgical subspecialties during 2011-2018 based on MEDLINE and EMBASE search. The primary objective of the present study was to quantitatively and qualitatively analyze the RCTs published from India based on year of publication, geographical distribution, and subspecialty using the modified Jadad score (high quality if score is ≥3; or ≥2 if blinded design was not feasible). Its secondary objective was to identify factors affecting the quality of RCTs. Results: Among 1304 trials identified, 162 were analyzed. Of these 96 (59%) had a score of ≥3; and 104 (64.2%) were of high quality (score ≥2). Year-wise there was no significant quantitative (P = 0.329) or qualitative (P = 0.255) variation. Geographic regions had similar quantity (P = 0.206) and quality (P = 0.068). The RCTs among subspecialties too were comparable in quantity and quality. Higher impact factor of journal (P = 0.013) and assessment by Institute Review Board (IRB) (P = 0.004) were significantly associated with a better study quality. Type of institution, number of authors, centricity, assistance by a statistician, and source of funding did not affect the quality of RCTs. Conclusions: : The quantity and quality of surgical RCTs were stable and comparable over the years and across geographical regions and subspecialties. Higher impact factor of journal and review by IRB were significantly associated with a better study quality.

Expression of stem cell marker cytokeratin 19 in reduced enamel epithelium, dentigerous cyst and unicystic ameloblastoma - A comparative analysis.

BACKGROUND: The process of odontogenesis is complex involving epithelial-mesenchymal interactions, along with the molecular signaling pathways triggering the initiating process. The triggering factors and cells precisely involved in the pathogenesis of odontogenic cysts and tumors are unknown. There is a vast array of biomarkers used to stain different sites, thereby helpful in diagnosing and evaluating the prognosis of these cysts and tumors. Cytokeratins are the intermediate filament proteins which maintain cell integrity and alter their properties in cysts and tumors. In the following study, cytokeratin 19 expression patterns are assessed quantitatively in reduced enamel epithelium, dentigerous cyst and unicystic ameloblastoma. AIM: The aim of present study is to assess expression of CK 19, a stem cell marker in reduced enamel epithelium, dentigerous cyst and unicystic ameloblastoma, quantitatively. MATERIALS AND METHODS: The present study is carried out with 15 samples in each group. Reduced enamel epithelium is derived from the patients undergoing treatment for impacted teeth. Histopathologically diagnosed cases of dentigerous cyst and unicystic ameloblastoma were considered for the study. With the help of Olympus BX 43 microscope, with ProgRes microscope camera, the 45 slides obtained were examined. The region of interest was selected in each slide and number of cells positively stained was counted. Data were analyzed using SPSS software version 23. Descriptive for scale data, One way anova with post hoc Tukey's test for intergroup comparison. RESULTS: The results showed significant P value <0.05. Expression of CK 19 was highest in reduced enamel epithelium, followed by dentigerous cyst and unicystic ameloblastoma. CONCLUSION: CK 19 can be used as diagnostic marker to differentiate between odontogenic cyst and tumor.

Diagnostic accuracy of Alvarado, RIPASA and Tzanakis scoring system in acute appendicitis: A prospective observational study.

Our prospective observational study, enrolling 167 patients undergoing emergency appendicectomy, served to evaluate the Alvarado, Tzanakis and RIPASA diagnostic scores. The latter was found to be a better scoring system because of its higher diagnostic accuracy. At centres with limited expertise in ultrasonography, RIPASA outperforms the Tzanakis score. Although easy to use, the Alvarado score was useful only to 'rule in' cases with AA with significant accuracy but at the cost of low sensitivity. It cannot be effectively used in triaging.

Restrictive versus liberal transfusion strategy in upper gastrointestinal bleeding: A randomized controlled trial.

BACKGROUND: The study aimed at comparing restrictive and liberal transfusion strategy in reducing mortality in patients with upper gastrointestinal bleeding (UGIB). METHODS: This was a single-center, prospective, open-label, non-inferiority, randomized controlled trial conducted over two years. Patients presenting with UGIB were randomized into restrictive (hemoglobin (Hb) <7 g/dl) or liberal (Hb <8 g/dl) transfusion strategy groups. Transfusion was given till patients achieved target Hb of 9 g/dl in restrictive and 10 g/dl in the liberal arms. Patients with exsanguinating bleeding, transfusion within 90 days, recent history of trauma or surgery were excluded. Primary outcome was mortality rate and the secondary outcomes were morbidity, re-bleeding episodes and the need for intervention. RESULTS: A total of 224 patients were randomized to 112 patients in each group. Demographic characteristics were comparable. 45-day mortality was similar between the two groups (restrictive vs. liberal; 10/112 vs. 12/112; P = 0.65). The number of in-hospital bleeding episodes (12 vs. 9; P = 0.25), incidence of re-bleeding during the 45-day follow-up (13 vs. 14; P = 0.84), need for endoscopic banding for varices (37/112 vs. 39/112, P = 0.99), mean hospital stay (days) (3.21 ± 2.78 vs. 2.73 ± 1.29; P = 0.10) were similar between the two groups. CONCLUSION: Restrictive transfusion strategy is non-inferior to liberal transfusion strategy in patients with UGIB.

A Comparative Study of Fine-Needle Aspiration and Nonaspiration Cytology Diagnosis in Thyroid Lesions.

BACKGROUND: Aspiration cytology is one of the first-line diagnostic tests in thyroid malignancies. Fine-needle aspiration cytology (FNAC) in thyroid lesions causes hemorrhagic smear and cell trauma, often leading to the repetition of smear and delay in diagnosis. This study was conducted to identify the diagnostically superior technique with regard to thyroid swelling and to assess the quality of smears obtained from FNAC and fine-needle nonaspiration cytology (FNNAC). METHODOLOGY: This was a prospective diagnostic study carried out for 2 years in a tertiary care center from South India. All patients with complaints of thyroid swellings, after examination, underwent FNNAC, followed by FNAC of the lesion. They underwent thyroidectomy when indicated. The final postoperative biopsy reports were compared with the preoperative reports of these two techniques (FNNAC and FNAC). The quality of smears was compared using Mair's score. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing malignancy were 93.4%, 100%, 100%, 98.78%, and 98.96% for FNNAC and 94.12%, 100%, 100%, 98.82%, and 99% for FNAC, respectively, which were comparable. Regarding the quality of smears, FNNAC had more smears with less blood in the background. FNAC had more smears with adequate cellularity. The difference in overall Mair's score between the two techniques was not significant (P = 0.28). CONCLUSION: No difference was found in the accuracy of FNAC and FNNAC in diagnosing thyroid lesions. Furthermore, the smear quality of both techniques was comparable. Hence, either can be used based on the operator's preference and experience.

Gender determination using barr bodies from teeth exposed to high temperatures.

CONTEXT: Gender determination forms a prime step in the forensic identification process. Teeth form a very important identification aid in forensic studies because they are protected by oral tissues and dental pulp is further protected by the mineralized constituents of the teeth. This allows the conservation and sustainable production of dental pulp to help sex determination in circumstances where other tissues cannot be analyzed like victims when exposed to high temperatures during fire accidents, explosions, and other mass disasters. AIM: The present study aimed at gender determination from pulpal tissue extirpated from teeth exposed to high temperatures. MATERIALS AND METHODOLOGY: The study consisted of sixty teeth samples, thirty male and thirty female. The teeth have been subjected to a series of temperatures of 37°C, 100°C, 200°C, 300°C, 400°C, 500°C, 600°C, 800°C, and 1000°C. The dental pulp is then obtained from these teeth, processed, stained, and checked for Barr bodies. STATISTICAL ANALYSIS USED: Descriptive statistical analysis has been used. RESULTS: The results showed that pulp from the female teeth showed the presence of Barr bodies up to a maximum of 400°C, whereas the male pulpal tissue did not show the presence of any Barr bodies. With increase in temperatures, the cellularity of the connective tissue decreased but the average number of Barr body positive cells remained constant within the range of 19-20. CONCLUSIONS: Dental pulp acts as a potential source of gender determination when no other means of identification are available.

Palliation of Dysphagia in Carcinoma Esophagus.

Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of dysphagia needs to be chosen for the patient. This study aims to discuss the recent trends in palliation of dysphagia with promising results and the most suitable therapy for palliation of dysphagia in a given patient. A total of 64 articles that were published between years 2005 and 2015 on various modes of palliation of dysphagia in carcinoma esophagus were studied, which were mainly randomized and prospective studies. Through this study, we conclude that stents are the first choice of therapy for palliation, which is safe and cost-effective, and they can be combined with either radiotherapy or chemotherapy for long-term palliation of dysphagia with good quality of life. Radiotherapy can be used as a second-line treatment modality.

Role of preprocedural rinse and high volume evacuator in reducing bacterial contamination in bioaerosols.

CONTEXT: Microbial contamination, which occurs during dental procedures, has been a potential threat to dental professionals and individuals. There has been a growing concern over the role of bioaerosols in spread of various airborne infections and also to reduce the risk of bioaerosol contamination. AIMS: This study was to analyze the number of colony forming units (CFUs) in bioaerosols generated during ultrasonic scaling procedure as well as to evaluate the efficacy of chlorhexidine 0.12% (CHX) preprocedural mouth rinse and high volume evacuator (HVE) in minimizing the bioaerosol contamination. METHODS: About 45 individuals were divided into three Groups A, B and C. These groups underwent ultrasonic scaling before and after the use of CHX (0.12%), HVE and combination of CHX (0.12%) and HVE. Bioaerosols were collected on blood agar plates which were incubated at 37°C for 48 h, and the CFUs were counted with manual colony counting device. A comparison was also done between A versus B, B versus C and A versus C groups. STATISTICAL ANALYSIS USED: Student's t-test. RESULTS: We found a significant reduction in the CFUs when CHX (0.12%) preprocedural rinse (P < 0), or HVE (P < 0.001) or combination of both CHX (0.12%) and HVE were employed (P < 0.001). Maximum reduction in CFUs was observed when CHX (0.12%) and HVE were used in combination as compared to their individual use. A moderate significance was seen between A versus C groups but not with B versus C groups and A versus B groups. CONCLUSION: From our study, we conclude that individual methods such as CHX (0.12%) and HVE were useful to reduce the dental bioaerosols; however, combination of both CHX (0.12%) and HVE is more efficient to reduce dental bioaerosols than individual method.

Salivary alkaline phosphatase levels speak about association of smoking, diabetes and potentially malignant diseases???

BACKGROUND: Alkaline phosphatase (ALP) is a hydrolase intracellular enzyme participating in the metabolic processes of cells. Rise in salivary ALP (S-ALP) levels reflects inflammation and destruction of healthy tissues suggesting it as a clinical biomarker. S-ALP is used in analyzing the severity of the disease occurrence in smokers and nonsmokers who are diabetic and nondiabetic. S-ALP levels are analyzed using autoanalyzer in 40 patients who visited our department. AIMS AND OBJECTIVES: To determine the levels of S-ALP in diagnosing potentially malignant conditions and debilitating diseases in early stages of inflammation and altered cellular metabolism. MATERIALS AND METHODS: The study groups include: (1) Group A - 10 smokers who are diabetic. (2) Group B - 10 smokers who are nondiabetic. (3) Group C - 10 nonsmokers who are diabetic. (4) Group D - 10 nonsmokers and nondiabetic as control. Unstimulated saliva samples are collected and run in auto-analyzer with ALP enzyme reagent to analyze ALP levels. Comparison is made between all the four groups. RESULTS: Results were statistically significant with increased activity of ALP levels in saliva from Group A when compared to Group D. The results are Group A > Group B > Group C > Group D. The results also revealed significant raise in levels of ALP levels in saliva from smokers when compared to diabetes. Thus explaining adverse effects of smoking. CONCLUSION: S-ALP can be considered to be the biomarker for evaluating adverse effects of smoking, diabetes and other debilitating diseases in early stages.

Analysis of lipid profile in cancer patients, smokers, and nonsmokers.

BACKGROUND: Lipids play an important role in maintaining the cell membrane integrity. Lipid profile is a panel of blood tests that serve as an initial medical screening for abnormalities in lipids and approximate risk for cancer, cardiovascular diseases, pancreatitis, etc., The present study evaluates the alterations in lipid profile in cancer patients, smokers, and nonsmokers and aims to achieve a correlation between them. MATERIALS AND METHODS: The study is an in vitro type of cross-sectional study with 25 oral cancer patients, 25 chronic smokers (habit persisting for 15 years or more), and 15 nonsmokers as control group. Blood samples had been collected, and triglycerides (TGs), total cholesterol (TC), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), and low-density lipoprotein (LDL) were analyzed using a lipid profile kit and an autoanalyzer. The results were analyzed using the unpaired t-test and ANOVA test (P < 0.05). RESULTS: There was a significant increase in TC, TG, LDL, and VLDL and decrease in HDL in the smokers group when compared to the controls (P < 0.05). A significant increase in LDL, but a decrease in values of HDL, VLDL, TG, and TC was observed in the cancer patients group when compared to the controls (P < 0.05). CONCLUSION: There is an inverse relationship between serum lipid profile in smokers and cancer patients. The decrease in lipid profile in cancer patients might be due to their increased utilization of lipids by neoplastic cells in membrane biogenesis. Therefore, a decrease in lipid profile in smokers can be assumed that they might be more prone to develop cancerous conditions.

Assessment of Abdominal Muscle's Maximal Force of Contraction Using Surface EMG in Inguinal Hernia Patients.

INTRODUCTION: Reduction in abdominal muscle's strength has been implicated in the development of inguinal hernia. Patients with inguinal hernia on one side are shown to be at higher risk of developing inguinal hernia on the other side. AIM: To assess the abdominal muscle strength in inguinal hernia subjects using surface Electromyography (EMG) and compare it with healthy controls. MATERIALS AND METHODS: This is a cross-sectional study involving only male subjects. Abdominal (Inguinal) hernia subjects without any known complications were recruited from surgery department and the accompanying healthy individuals were taken as control (Control, n=44, inguinal hernia subjects, n=43). The subjects were asked to perform maximal contraction for three seconds targeting external and internal oblique muscles of right and left sides separately. Motor unit potentials were recorded using surface EMG for individual muscles on both sides during maximal contraction. The maximum amplitude of the motor unit potentials obtained was considered as the strength of the respective muscle. RESULTS: In control group, there was no significant difference in strength of external and internal oblique muscles between the two sides. Strength of external and internal oblique muscles of both herniated and unaffected side was reduced in inguinal hernia subjects as compared to healthy controls. Further, the muscle strength of herniated side was less as compared to unaffected side in the inguinal hernia subjects. CONCLUSION: Abdominal muscle strength is reduced in hernia subjects and even the apparently normal side strength is less as compared to controls. This should be considered while performing corrective surgeries in inguinal hernia subjects.

Efficacy of Specific Plant Products on Microorganisms Causing Dental Caries.

INTRODUCTION: Dental caries and periodontal diseases are the most common oral diseases seen globally, both in developed and developing countries. Oral microorganisms that is gram positive and gram negative bacteria are known to be involved in causation of these diseases. Nowadays commercially available dentrifices and mouth rinses are known to contain ingredients that can alter the oral microbial flora and have undesirable side effects such as vomiting, diarrhoea, disarrangement of oral, intestinal flora and tooth staining. Naturally available plant products are known to be less harmful with fewer side effects and also economical for the patient. AIM: The aim of this study was to determine the antimicrobial properties of 10 naturally available plant products against oral microorganisms causing caries and to check the efficacy of these products in-vitro and to use these in mouth washes and dentrifices. MATERIALS AND METHODS: Sample of caries material was scrapped out from the extracted teeth and transferred to liquid broth, streaked over the agar media to allow for the growth of microorganisms. Plant products like clove oil, neem, ginger-garlic paste, tea tree oil, ginger, garlic, cinnamon oil, green tea, eucalyptus oil and turmeric were used. Antimicrobial efficacy of these products, was estimated by measuring zones of inhibition in the nutrient agar media. RESULTS: Clove oil was the most effective of all products against microorganisms causing caries with zone of inhibition - 30mm followed by ginger-garlic paste - 25mm, Neem - 15mm, tea tree oil - 15mm. CONCLUSION: Based on the above results, it can be inferred that these natural products have the maximum efficacy against microorganisms and can be recommended in dentifrices, mouth rinses, topical gels, etc.

Rhinomaxillary mucormycosis with palatal perforation: a case report.

Mucormycosis are a group of invasive infections caused by filamentous fungi of the Mucoraceae family. Mucormycosis is essentially limited to immunocompromised patients with poorly controlled diabetes mellitus, hematologic malignancy, organ transplant, chemotherapy, chronic renal insufficiency, malnutrition, deferoxamine therapy and severe burns. The fungi invade arteries leading to thrombosis that subsequently causes necrosis of hard and soft tissues. Here, we present a case report of a 50-year-old diabetic patient with rhinomaxillary form of mucormycosis.

Axial Torsion of Gangrenous Meckel's Diverticulum Causing Small Bowel Obstruction.

Meckel's diverticulum (MD) is a commonly encountered congenital anomaly of the small intestine. We report an extremely unusual case of an axially torted, gangrenous MD presenting as acute intestinal obstruction. A 26-year-old male patient presented to our emergency department with 3 days history of abdominal pain, distention and bilious vomiting. On laparotomy, there was minimal hemorrhagic fluid localized in right iliac fossa and small bowel loops were dilated. A MD was seen attached to the mesentery of nonadjacent small bowel by a peritoneal band. The diverticulum was axially torted and gangrenous. In addition, there was compression of ileum by the peritoneal band resulting in intestinal obstruction, which was relieved on dividing the band. Resection and anastomosis of the small bowel including the MD was performed. We hereby report a rare and unusual complication of a MD. Although treatment outcome is generally good, pre-operative diagnosis is often difficult.