Role of Dental Profession in Oral Cancer Prevention and Diagnosis.

The incidence of oral cancer is increasing worldwide. Malignant neoplasms of the mouth and pharynx have been rated as the 10th most common cancer in men and 7th in women, though geographical variations exist.1Generally, in a society, oral cancer is not properly understood. The sign and symptoms are frequently overlooked in the initial stages when it is responsive to treat.

Assessing the Risk of Oral Cancer associated with Gutka and Other Smokeless Tobacco Products: A Case-control Study.

INTRODUCTION: Tobacco and tobacco-related products have been attributed to be causative factors for oral cancer. Newer, chewable, and commercially available smokeless tobacco (ST) products, such as gutka pose further threat in this direction. The aim of the study was to evaluate the risk of oral cancer associated with gutka and other ST products. MATERIALS AND METHODS: A case-control study of 134 cases and 134 controls, over a period of 6 months (July-December 2014), was carried out at the Baqai University, Karachi, Pakistan. An interview-based questionnaire was used to collect data on sociodemographic characteristics, oral hygiene practices and type, duration, and frequency of use of tobacco-related products. Data were analyzed using the Pearson's chi-square (χ2) test with the level of significance set as p < 0.05. RESULTS: Gutka showed the highest odds ratio toward developing oral cancer ratio among all the tobacco-related products [odds ratio (OR) 5.54; 95% CI 2.83-10.83; p < 0.001)]. Participants who consumed other ST products also showed 2 to 4 times higher odds ratio of developing oral cancer than compared to those who did not consume these products. CONCLUSION: The study provided strong evidence that gutka and other ST products are independent risk factors for oral cancer. CLINICAL SIGNIFICANCE: This study highlights the strong association of different types of ST and oral cancer. This results in identification of high-risk groups for targeted screening for potential oral cancer lesions.

Detection of adrenomedullin and nitric oxide in different forms of periodontal disease.

BACKGROUND AND OBJECTIVE: The multifunctional molecules adrenomedullin (AM) and nitric oxide (NO) are both involved in the host response to microbial challenge during periodontal disease. Whether they coexist in periodontal inflammation and if equally produced in the different forms of periodontal disease has not previously been investigated. The aims of this study were to describe the locations of AM and NO in healthy and inflamed gingival tissues and to determine and compare their levels in the gingival crevicular fluid and saliva of patients with gingivitis, chronic periodontitis and aggressive periodontitis. MATERIAL AND METHODS: AM and inducible nitric oxide synthase (iNOS) were immunolocalized in clinically healthy and inflamed gingival tissue sections. The cells expressing AM and iNOS were characterized using immunocytochemistry with different markers for macrophages [cluster differentiation (CD)68 and CD14)], dendritic cells (CD83), neutrophils [neutrophil gelatinase-associated lipocalin (nGAL)] and natural killer cells (CD56). In an initial study, the levels of AM and NO were also measured in samples of gingival crevicular fluid and saliva obtained from patients with a diagnosis of gingivitis (n = 9), chronic periodontitis (n = 9) and aggressive periodontitis (n = 9) using an ELISA and the nitrate/nitrite (NO metabolites) Griess assay, respectively. RESULTS: Low levels of AM- and iNOS-expressing cells were detected in healthy gingival tissues in comparison with three-fold higher levels of these cells in inflamed tissues. These cells were localized mainly in the epithelial layer but were also present in deeper connective tissue. AM and iNOS were co-localized in particular cells within inflamed tissues, namely CD68(+) (52%) and CD14(+) (36%) macrophages, but also in nGAL(+) neutrophils (16%) and CD83(+) dendritic cells (14%). Interestingly, AM and NO levels in saliva were both found to be higher (p < 0.01) in patients with aggressive periodontitis than in patients with chronic periodontitis or gingivitis. In contrast, in gingival crevicular fluid, the levels of NO showed marked differences among patients with chronic periodontitis, aggressive periodontitis and gingivitis (p < 0.01), and the levels of AM were higher (p < 0.01) in both chronic and aggressive periodontitis compared with gingivitis alone. CONCLUSION: The data presented demonstrate a functional linkage between AM and NO in periodontal disease, with salivary and gingival crevicular fluid levels possibly associated with different forms and severities of periodontal disease. Exacerbated production of both AM and NO in saliva suggests their potential use as salivary markers of aggressive periodontitis.

Prevalence of polyomavirus among United Arab Emirates kidney transplant recipients: results from a single center.

BACKGROUND: BK viremia and nephropathy are increasing problems in renal transplant recipients. The absence of a safe and effective antiviral therapy made screening-based prevention a recommended strategy. The prevalence of its reactivation among recipients of kidney transplants in the Middle East has not been well established. Our objective was to determine the prevalence of BK virus (BKV) infection for renal transplant recipients at our medical center. METHODS: All renal transplant recipients followed up in our transplantation clinic between 2012 and 2013 (n = 116) were screened. Urine and blood quantitative real-time polymerase chain reaction (PCR) for the BKV were performed in all of the study patients. Renal biopsy was performed only in patients with deteriorating renal function associated with positive PCR. Patients who showed positive BKV PCR were followed up for 6 to 12 months. This included clinical and kidney function assessment along with BKV PCR viral load. RESULTS: Among the 116 kidney transplant recipients studied, 65 (56%) were male, age 51 ± 15 years, with a transplantation vintage of 131 ± 61 months; 17 (14.7%) were positive for BKV PCR. Three (2.7%) showed viremia; 2 of them had deterioration of kidney function, renal biopsy confirmed the diagnosis of BK nephropathy (NP) in both cases. The 3 cases were managed by reducing the immunosuppressive treatment with stabilization of their kidney function. Cases with stable renal function and positive urine for BKV cleared the virus spontaneously during follow-up after minor reduction of the immunosuppressive treatment or without any intervention. None of our patients lost the graft due to BK NP. CONCLUSION: Our study suggests that BKV is not uncommon in our kidney transplant recipients. Routine screening suggested by the KDIGO Guidelines could help minimize its detrimental impact on the transplant outcome.

Regulation of adrenomedullin and nitric oxide production by periodontal bacteria.

OBJECTIVES: In periodontitis the host response to bacterial challenge includes activity of the multifunctional molecules adrenomedullin (AM) and nitric oxide (NO). The aim of this study was to investigate the role of periodontal bacteria in regulating the production of these molecules from cultured cells. MATERIAL AND METHODS: Regulation of AM and NO production from oral keratinocytes when challenged with culture supernatants from Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Veillonella atypica, Streptococcus salivarius and Candida albicans was examined. AM and NO were measured in cell culture supernatants using an enzyme-linked immunosorbent assay and the nitrate/nitrite (NO metabolites) Griess assay respectively. Cellular production of AM and inducible NO synthase was also analysed in target cells by immunofluorescence and Western blot analysis. The inter-relationship of AM and NO production were further investigated with macrophages. RESULTS: A. actinomycetemcomitans and C. rectus induced maximal levels of both AM and NO after 6 and 48 h respectively from oral keratinocytes. AM production in macrophages was upregulated in response to the NO donor S-nitrosoglutathione and partially blocked by the inducible NO synthase inhibitor, N(ω) -Nitro-l-arginine methyl ester hydrochloride. Likewise, NO production was increased upon exposure to AM, while the AM receptor antagonist AM 22-52 reduced the release of NO. CONCLUSIONS: Pathogens associated with aggressive periodontitis, A. actinomycetemcomitans and C. rectus, were more effective than those associated with chronic periodontitis, P. gingivalis and Prev. intermedia, and commensals, S. salivarius and V. atypica, as regards the upregulation of AM and NO production from oral keratinocytes. Interaction between these molecules was also demonstrated with macrophages. Understanding the coordinated regulation of AM and NO production in response to periodontal bacteria may identify ways to promote their protective effects and minimize destructive potential.

An integrated systematic review and meta-analysis of published randomized controlled trials evaluating nasogastric against postpyloris (nasoduodenal and nasojejunal) feeding in critically ill patients admitted in intensive care unit.

This article presents the systematic review of the randomized, controlled trials comparing the effectiveness of nasogastric (NG) versus postpyloris (PP) feeding in critically ill surgical patients and other patients in intensive therapy unit (ITU). Twenty randomized trials recruiting 1496 patients were retrieved from the standard electronic databases. There were 760 patients in the NG feeding group and 736 patients in the PP feeding group. There was significant heterogeneity among trials. PP feeding in ITU patients was associated with lower gastric residual volume (odds ratio (OR), 3.95; 95% confidence interval (CI), 1.19, 13.14; z = 2.24; P<0.03; I(2) = 73%) and a reduced risk of developing aspiration pneumonia (OR, 1.41; 95% CI, 1.01, 1.98; z = 2.03; P<0.04; I(2) = 10%) compared with NG feeding. In addition, higher proportion of caloric requirements (standardized mean difference, -1.02; 95% CI, -1.73, -0.31; z = 2.82; P<0.005; I(2) = 95%) could be delivered with PP feeding. Risk of gastrointestinal complications, overall mortality and length of ITU stay were similar between the two techniques of enteral feeding. In summary, PP feeding in ITU patients reduces the gastric residual volume and risk of aspiration pneumonia. PP feeding is also superior to NG feeding in terms of delivering higher proportion of daily caloric requirements. PP feeding with the help of nasoduodenal or nasojejunal tube may be used routinely in ITU patients for nutritional support.

Post-catheterization pseudoaneurysm in a one-year-old child treated by ultrasound-guided human thrombin injection.

We report a successful treatment of iatrogenic post-catheterization pseudoaneurysm of the right common femoral artery in a one-year-old boy with ultrasound-guided percutaneous injection of human thrombin under general anesthesia. Physical examination after 2 months follow-up showed complete disappearance of the pulsating lump.

A comparative evaluation of immunotoxicity of malathion after subchronic exposure in experimental animals.

The effects of sub-chronic doses of malathion exposure on humoral and cell-mediated immune (CMI) responses were studied in male albino mice, rats and rabbits using sheep red blood cells (SRBC), tetanus toxoid and ovalbumin as antigens. The humoral immune response was assessed by estimating serum immunoglobulin (IgM and IgG) concentrations, antibody titre against antigens and splenic-plaque forming cells (PFC). The CMI response was studied by using the leucocyte migration inhibition (LMI) and macrophage migration inhibition (MMI) tests. In general there were (a) attenuation in antigen induced antibody response, (b) suppression of PFC, and (c) marked inhibition of LMI and MMI factors. Sub-chronic malathion exposure induced differential degrees of humoral and CMI suppression in these experimental animals. However, both cellular and humoral immune responses were decreased in a dose-time dependent pattern and a consistent trend was observed. The threshold level of the malathion for inducing immune suppression depends on the animal species, type of antigen used, and the method of immunological assay. In view of the widespread use of malathion a comparative assessment of immune responses using different experimental animals and antigens is an important aspect of its safety evaluation.

Resolution of enzyme bands of Plasmodium knowlesi as a function of substrate concentration.

An extra band of isoenzyme lactate dehydrogenase (LDH) was obtained in case of Plasmodium knowlesi free parasite as compared to normal monkey blood. This extra band could be resolved due to the decreasing amount of substrate concentration. Agarose electrophoresis technique was used to separate the isoenzyme bands.

Effect of sub-chronic endosulfan exposure on humoral and cell-mediated immune responses in albino rats.

The present study was designed to evaluate the effect of sub-chronic doses of endosulfan on humoral and cell-mediated immune (CMI) responses in albino rats. Male albino rats were given a diet containing 5, 10 or 20 ppm endosulfan for 8-22 weeks and immunized with tetanus toxoid in Freund's complete adjuvant subcutaneously 20 days before terminating the exposure. The humoral immune response was studied by serum globulin level, immunoglobulin (IgM and IgG) concentration and antibody titre against tetanus toxoid. The CMI response was studied by leucocyte migration inhibition (LMI) and macrophage migration inhibition (MMI) factors. The antigen-induced increases in serum globulin fraction and immunoglobulin level were reduced at high doses of the endosulfan after 12 weeks of exposure. Antibody titre was significantly decreased in endosulfan-exposed rats at 10 and 20 ppm levels and a consistent trend was observed. Rats in the 10 and 20 ppm dose groups had significantly depressed LMI and MMI responses. Results obtained in this study revealed marked suppression of the humoral and CMI responses in rats administered with sub-chronic doses of endosulfan. Both cellular and humoral immune responses were decreased in a dose-time dependent pattern. Suppression of immune responses by endosulfan is clearly an important aspect of its toxicology.

Trypsin-sensitive plasmodia in the liver of post-infection rats and rhesus monkeys.

Kupffer cells from the liver and erythrocytes from peripheral blood were collected at the post-patent period from albino rats infected earlier with Plasmodium berghei and rhesus monkeys infected earlier with P. cynomolgi var. bastianelli or P. knowlesi. The cells were subinoculated into individual normal recipients. These recipients subsequently showed parasitaemia in their circulation. The parasites present in Kupffer cell preparations were found to be sensitive to trypsin treatment, while those in erythrocytes were found to be resistant to trypsin treatment. This differential sensitivity of parasites to trypsin was observed in all the three species of plasmodia studied so far.

Effect of dietary protein, dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) on hepatic microsomal enzyme activity in rats.

1. Albino rats were fed on diets containing 30, 120 or 200 g protein/kg with or without the incorporation of dichlorodiphenyltrichloroethane (DDT) or hexachlorocyclohexane (HCH) at 100 mg/kg diet for 4 weeks. 2. The activities of the liver microsomal enzymes NADPH-cytochrome reductase (EC 1.6.2.4), flavoprotein-linked monooxygenase (EC 1.14.14.1) and O-demethylase were significantly greater in animals fed on 120 and 200 g protein/kg diet compared with those fed on 30 g protein/kg diet. 3. The inclusion of DDT or HCH at all protein intakes led to further significant rises in microsomal enzyme activities but the increases were much greater for animals receiving the 120 and 200 g protein/kg diets than for those receiving the 30 g protein/kg diet. 4. The results imply that detoxification of DDT or HCH was carried out more effectively at the higher protein intakes.