Maxillary Mucormycotic Osteonecrosis as a Manifestation of Post-COVID-19 Infection in Non-diabetic Patients: Report of Two Cases.

Mucormycosis is a rare, opportunistic fungal infection prevalent in the elderly, especially in patients with uncontrolled diabetes or a compromised immune system. However, the outbreak of the pandemic declared by the World Health Organization in late 2019 increased the incidence of mucormycosis cases in COVID-19 patients due to increased steroid usage that resulted in an immunocompromised state. The current report presents two cases of oral mucormycotic osteomyelitis in patients who developed diabetes post-COVID infection, along with a review and relevant literature.

Ganglion cyst of temporomandibular joint - A systematic review.

Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.

Inhibitory effect of garlic and omam extracts on Mucor circinelloides, a fungus causing mucormycosis: An in vitro study.

Context: Mucor circinelloides is reported to be the second among the most common causative agents of emerging mucormycosis. It is intrinsically resistant to most known antifungals. Further the use of antifungals cause side effects. Traditional knowledge system for treating various ailments is stronger in India and it also backs deriving various bioactive compounds from herbal sources, in the modern system of medicine. Therefore, two most commonly used culinary herbal materials viz., ginger and omam were studied in vitro against M. circinelloides, as an alternate to antifungal drugs. Aims: To explore the traditional herbal resources as alternate to Amphotericin B to use against M. circinelloides, a fungus causing mucormycosis. Methods and Material: Aqueous extracts of garlic and omam were prepared and tested against M. circinelloides, at different concentrations. A positive control with Amphotericin B and negative control without any supplements were also maintained. The inhibitory effect was assessed by adopting optical density (OD) measurement method in SD broth and SD Agar Well Plate using spore suspension as inoculum. Statistical Analysis Used: Paired student T test was employed using SPSS Version 1.6. Results and Conclusions: Both garlic and omam extracts were found to inhibit the M. circinelloides and their MICs were 600 and 700 µL/mL. It is comparable with the MIC of Amphotericin B, 200 µg/mL. Thus, the regular use of garlic and omam can reduce the risk of possible mucormycosis and these herbs can be explored for drug formulations against M. circinelloides.

Evaluation of the Anti-Carcinogenic Effect of Centella Asiatica on Oral Cancer Cell Line: In vitro Study.

OBJECTIVE: To evaluate the anti-carcinogenic effect of Centella Asiatica on to evaluate the  Anti-Carcinogenic Effect of Centella Asiatica on Oral Cancer Cell Line oral cancer cell line. MATERIALS AND METHODS:  Oral Cancer cell line and normal oral keratinocyte cell line were procured.Centella asiatica extract was prepared. The cells were then subjected to the test herbal specimens -Centella asiatica extract in succeeding concentrations of 25 µg/ml, 50 µg/ml, 100 µg/ml at time intervals of 24,48 and 72 hours. Cisplatin (2 µg/ml, 4 µg/ml, 6 µg/ml, 8 µg/ml) was used as a positive control. This experiment was done in triplets. RESULTS: The study revealed that the p values were less than 0.05 at concentration 12.5µg/ml, 25µg/ml, 50 µg/ml,100 µg/ml and time period of 24hrs,48hrs,72hrs, thus implying that at these concentrations and time period, the obtained data were statistically significant, thus indicating that there is a statistically significantly decreases in the viable cells as the concentration of the drug as a time period increases The results reveals that  centella asiatica possess potential effect of anti-carcinogenic, effect when compared to positive control (Cisplatin). CONCLUSION: The current study reveals that Centella asiatica has an potential anti-carcinogenic effect on oral cancer cell line. So this can be used to treat oral cancer with minimal crippling as compared with allopathic drugs.

Analysis of Metabolic Regulators PGC1-α and PGC1-ß in Oral Squamous Cell Carcinoma with and without Hyperglycemia.

AIM: To assess the expression of PGC1-α and PGC1-ß in Oral squamous cell carcinoma in the presence and absence of hyperglycemia. MATERIALS AND METHODS: Fresh tissue samples were collected from 14 well differentiated OSCC patients with hyperglycemia, 14 OSCC patients without hyperglycemia  and 14 healthy controls and subjected to quantitative real-time PCR to assess expression of PGC1-α and PGC1-ß. The relative gene expression of PGC1-α and PGC1-ß was calculated using the double delta Ct method. A two-fold difference was defined as over or under- expression.  To further evaluate clinicopathological association, Independent t-test was employed. RESULTS: The expression of both PGC1-α and PGC1-ß were increased in OSCC patients when compared to healthy controls and similar findings were observed on calculating the fold change healthy controls and OSCC study groups. On assessing the expression of target genes within study groups, they did not present with significant fold change and the hyperglycemic status of the individual did not contribute to the expression of the target genes as P value obtained for PGC1-α and PGC1-ß were >0.05. CONCLUSION: The hyperglycemic status of the individual does not influence the expression of PGC1-α and PGC1-ß in OSCC tissues and the cause for over-expression of the study targets in OSCC tissues must be further evaluated  to assess their potential as possible candidates for targeted therapy in OSCC patients.

Dentin degradonomics - The potential role of salivary MMP-8 in dentin caries.

BACKGROUND: Dentin caries involves dissolution of minerals which eventually leads to degradation of organic matrix. This degradation which was thought to be by bacterial proteases is now considered to be orchestrated by endogenous collagenases such as Matrix Metalloproteinases (MMPs). This paper aims to estimate the salivary levels of MMP-8 in dental caries and also to asses the various risk factors that contribute to the formation of dental caries. MATERIAL AND METHODS: A random sample of 75 adults aged 18-35 were included and categorized based on the number of caries lesions (MCL). Standard clinical examinations were performed, and stimulated saliva was collected and analyzed for concentrations of MMP-8 using enzyme-linked immunosorbent assay. Caries risk factors were assessed using a chair-side kit. Correlation of MMP-8 in varying MCL using Spearman's correlation was done. Multiple linear regression analysis was done to asses the relationship between various caries risk factors with MMP-8 and MCL as dependent variable. RESULTS: The study results showed a statistically significant higher concentration of MMP-8 in carious group (MCL 1-2) and MCL ≥3 compared to non-carious group. On correlating, the levels of MMP-8 were seen to be higher in MCL ≥3 than in MCL = 0 and MCL 1-2. The mean MMP-8 of controls, MCL 1-2, and MCL ≥3 were 131.34ng/ml, 230.14ng/ml, and 391.91ng/ml respectively. Multiple linear regression analysis with MMP-8 as the dependent variable revealed caries, buffer capacity and S. mutans count as significant variables. Using MCL as the dependent variable the only significant variable was MMP-8 levels. CONCLUSIONS: The study suggests that subjects with caries have elevated MMP-8 levels compared with subjects with no carious lesions. There is also a positive correlation between the number of carious lesions and MMP-8 levels suggesting that MMP-8 plays an important role in the degradation of dentin and causes progression of caries. Key words:Caries, Dentin, Enzyme-linked Immunosorbent Assay, MMP-8.

Evaluation of antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on Streptococcus mutans, Lactobacillus species and Actinomyces viscosus: An in vitro study.

INTRODUCTION: The Ayurvedic system of medicine is popular in India and has gone through various change and remains as the mainstay of medical relief to a large population. Dental caries is the one of the major issue in the recent time, and there is no definite caries prevention method so far apart from Topical fluoride application, regular oral hygiene measures, pit and fissure sealants and diet measure. In spite of the above mentioned preventive measures the people are still prone to dental caries. In order to find a better solution the present study evaluates the antimicrobial properties widely available and cost effective herbal extracts of Solanum xanthocarpum and Pistacia lentiscus extract on cariogenic oral microbial flora. AIM: To Evaluate the Antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on cariogenic oral microbial flora. METHODOLOGY: The antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on cariogenic oral microbial flora (streptococcus mutans, lactobacillus, actinomyces viscosus) by different culture techniques to estimate the zone of inhibition (well diffusion method) and minimum inhibitory concentration (tube dilution method). RESULTS: The antimicrobial efficacy of Solanum xanthocarpum and Pistacia lentiscus on test bacteria were analysed using kurskal wallis test and values of 0.003 and 0.002 were obtained respectively, since the p values were less than 0.005, indicating that both herbal products possess statistically significant antimicrobial properties. CONCLUSION: The antimicrobial effects of the herbal extracts were almost on par with commercially available allopathic agents like chlorhexidine on oral cariogenic microbes. The efficacy should be further validated in a large scale studies and can be utilized for caries prevention in the form of mouth rinses, dentifrices and topical application in the future.

Salivary and Serum Interleukin-6 Levels in Oral Premalignant Disorders and Squamous Cell Carcinoma: Diagnostic Value and Clinicopathologic Correlations

Aim: To assess the diagnostic utility of serum and salivary interleukin 6 (IL-6) levels in the differential diagnosis of potentially malignant lesions and conditions (PMLs/PMCs) and oral squamous cell carcinoma (OSCC) in a high oral cancer prevalence region. Methods: After appropriate ethical clearance and informed consent, salivary and blood samples were collected from 100 participants in each group (OSCC, PMLs, and healthy controls). Serum and salivary IL-6 levels were measured by enzyme-linked immunosorbent assay and data were subjected to appropriate statistical analysis. Results: Significant differences in IL-6 concentration were noted between OSCC and PML/C patients in both serum and saliva, with salivary levels being 2 to 3 fold higher than serum values in all the groups. Receiver operating characteristic curve analysis demonstrated 96% specificity and 99% sensitivity for salivary IL-6 in differentiating PML from OSCC. Conclusions: The results of the present study suggest that the pro-inflammatory cytokine, IL-6, is elevated in the saliva of patients with OSSC compared to PMD and controls, and thus may prove to have diagnostic and/or prognostic significance.

Salivary Her2/neu Levels in Differentiation of Oral Premalignant Disorders and Oral Squamous Cell Carcinomas.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is thought to develop from precancerous dysplastic lesions through multistep processes of carcinogenesis involving activation of oncogenes and loss of tumor suppressor genes. The human epidermal growth factor receptor 2 (Her-2/neu [erbB-2]), a cell membrane glycoprotein, is a growth factor receptor that has receptor tyrosine kinase activity. Her2/neu activation plays a central role in cell proliferation and survival. It has been shown that overexpression of Her2/neu increases the rate of cell division and growth, leading to precancerous changes. The aim of the present study was to compare the serum and salivary Her2/neu levels between cases with premalignant and malignant oral lesions. MATERIALS AND METHODS: Fasting blood samples and unstimulated saliva by passive drooling were collected from three groups of healthy control (n=20), premalignant disorder (PMD) (n=20) and OSCC (n=25) subjects. The HER2 extracellular domain (HER2 ECD) levels were measured using ELISA. RESULTS: The levels of serum Her2/neu showed no significant differences between any of the groups but on the other hand salivary Her2/neu levels were found to be significantly (p<0.05) higher when compared between control (median 68.7 pg/ml, range: 21.5 - 75.8) and OSCC (median 145.6 pg/ml, range: 45.1-191.1). A similar trend was observed when comparing between PMD (median 43.3, range: 22.1 -94.7) and OSCC with a statistical significance of p<0.05. CONCLUSIONS: Our study provided evidence of increased salivary Her2/neu in OSCC when compared to PMD and control which was not the case for serum levels. This suggests that probably Her2/neu is not highly amplified as in breast cancer so as to be reflected in serum. Since saliva is in local vicinity of the OSCC, even a mild increase might be mirrored. On the whole, this study proposes Her2/neu as marker for distinguishing premalignant and malignant conditions.

Oral mucocutaneous lesions - a comparative clinicopathological and immunofluorescence study.

BACKGROUND: Oral mucosa is often affected by many diseases including mucocutaneous disorders. The diagnoses of these disorders are primarily based on history, clinical features, and histopathology. For the past few years' immunofluorescence techniques emerged as an important tool to study the pathogenesis and in the diagnosis of oral mucocutaneous and vesiculobullous disorders. The present study was designed to carry out retrospective and prospective analysis of oral mucocutaneous lesions to elucidate the clinicopathologic features and its immunofluorescence findings. MATERIALS AND METHODS: A total of 70 subjects with oral mucocutaneous lesions were retrieved from the oral pathology files of Tamil Nadu Govt. Dental College and their clinical features were evaluated, and the histopathology was also evaluated with the help of hematoxylin and eosin stained sections. For the prospective study, biopsy from 12 subjects with oral mucocutaneous lesions was subjected to routine histopathological examination and DIF to evaluate the consistency of the methods. RESULTS: In the retrospective analysis of 70 subjects with oral mucocutaneous lesions in relation to clinical features and histopathology, most of the findings were similar to the previous studies except for few criteria like male predilection in lichen planus and mucous membrane pemphigoid (MMP) and more prevalence of pemphigus vulgaris than MMP (2:1). In the prospective analysis of 12 subjects, the histopathological diagnosis was consistent with DIF study in 66% of cases. CONCLUSION: The diagnostic efficiency of oral mucocutaneous lesions can be improved by modern tools like DIF studies in addition to traditional methods like clinical and histopathology.

Rhinosporidiosis presenting as a facial swelling: a case report.

Rhinosporidiosis caused by Rhinosporidium seeberi is a fungal infection, which affects chiefly the mucus membranes of the nose, oropharynx, and nasopharynx, as well as the larynx, skin, eyes, and genital mucosa. Soil and water act as a reservoir for the organism. Here, we present a case of Rhinosporidiosis, which clinically manifested as a facial swelling indicating that fungal infections should also be considered as one of the differential diagnoses whenever facial swellings are encountered.