Colonic phenotype of adenocarcinoma base of the tongue: An entity rarely reported and treated with definitive chemoradiation p. 116 Neelam Sharma, Abhishek Purkayastha, Chhavi Arora, Kavita Sahai DOI:10.4103/ijohs.ijohs_55_17 The predominant histological type of oropharyngeal cancer is squamous cell carcinoma and approximately 9 times more frequent when compared with other types. Adenocarcinoma common histopathology for digestive system is very rarely reported in this region. In literature, there are limited data about the clinical presentation, histopathology, and treatment modalities for the primary adenocarcinoma of the base of the tongue (BOT). To the best of our knowledge, five cases of adenocarcinoma of the BOT with colonic differentiation have been reported in the world literature till date, and this is the first case report from India. The challenge in these type of cases is to differentiate between the primary adenocarcinoma of BOT which is extremely rare, metastatic lesion to this site from any other site, or its origin from minor salivary glands which is a more common possibility because all these situations have different treatment implications. http://www.ijohsjournal.org/currentissue.asp?sabs=y
The benefits of prostate specific antigen (PSA) screening for prostate cancer in men has been under controversy for a number of years. Some of the issues are that although prostate cancer is the second leading cause of cancer death in men, most prostate cancers are slow-growing and never cause problems. And while PSA screening can detect cancer early, when it is curable, it is most commonly positive with benign prostatic hyperplasia (BPH), not prostate cancer. (For more details about the issues, see the articles on PSA and Prostate Cancer.)
An international panel of experts recently published in The BMJ (formerly the British Medical Journal) their "Rapid Recommendations" that outlined initiatives advising against routine PSA screening for prostate cancer. Moreover, they suggest that healthcare practitioners should not feel compelled to routinely ask patients about their desire for screening, though they should help patients who raise the issue to make an informed decision.
The recommendations state that for most men, the benefit of screening is small and uncertain, and that there are clear harms and possible side-effects involved in follow-up treatment for positive PSA results. The panel acknowledges that these recommendations may not apply to all men, especially those who have a family history of prostate cancer, are of African descent, or of lower socioeconomic status. For these men, the panel recommends shared decision-making between the patient and the healthcare practitioner.
However, The BMJ panel's guidance contrasts with advice from other organizations that also issue PSA screening recommendations. The U.S. Preventive Services Task Force (USPSTF) earlier this year updated and finalized guidelines that moved from recommending against routine PSA screening to advising that men ages 55 to 69 discuss the issue with their healthcare practitioners to make an informed decision about whether screening is right for them. The Task Force did recommend that men age 70 or older would not need screening.
The change came about after the Task Force reviewed published data on 1,904,950 men on the use of PSA testing to screen for cancer. The USPSTF team's research revealed that the potential harms and benefits of PSA screening for this population are about the same, leading them to conclude that the decision to screen "should be an individual one." Men considering screening should weigh the potential benefits and harms, including:
Potential benefits of PSA screening
Early detection of cancer when it is most treatable would potentially lower the risk of cancer death for some men.
Detecting any prostate cancer for men who value knowing their cancer status over possible PSA screening harms
Potential harms of PSA screening
A false-positive test result (when a man has an elevated PSA level but does not have prostate cancer) could lead to stress and more unnecessary tests, including a prostate biopsy. Possible prostate biopsy side-effects and complications include blood in semen, blood in urine, pain, fever, and sepsis.
The overdiagnosis and treatment of men with prostate cancer who would never have symptoms or die from their cancer; treatment, which typically includes surgery, chemotherapy and/or radiation therapy, can lead to urinary incontinence, bowel dysfunction and erectile dysfunction. Some men may avoid harms of overtreatment by choosing not to treat immediately but opting for "watchful waiting," which may include occasional PSA tests, or "active surveillance" that involves PSA tests done about every six months with digital rectal examsand prostate biopsies (annually) to monitor the cancer.
The BMJ panel came to their conclusion based on a detailed review and analysis of over 700,000 men in five PSA screening clinical trials who had no previous diagnosis of prostate cancer. Analyses of the clinical trial data revealed that for this population of men, PSA screening reduces prostate cancer deaths, but the effect is small. Most of the men with elevated PSA levels opted to have a prostate biopsy, but no cancer was found. As for the small number of men whose elevated PSA levels were consistent with prostate cancer, many would never experience symptoms or die from their cancer. Therefore, the panel issued a "weak recommendation" against healthcare providers actively offering PSA screening to their patients.
The BMJ panel's recommendation is categorized as weak because of the "small and uncertain benefits of screening on prostate cancer mortality and the large variability in men's values and preferences." More simply put, a weak recommendation means that shared decision-making is important. For men who ask about PSA screening, The BMJ panel urges healthcare providers to share information with their patients so that they can make educated decisions for themselves.
The American Academy of Family Physicians agrees with The BMJ Rapid Recommendations, while other groups, including the American Cancer Society, the American Urological Association, the American College of Physicians, and the U.S. National Comprehensive Cancer Network, have issued PSA screening recommendations that are similar to those of the USPSTF.
An international consortium that included the American Society of Reproductive Medicine, the Centre for Research Excellence in PCOS in Australia, and the European Society of Human Reproduction and Embryology has released new guidelines on polycystic ovary syndrome (PCOS), a condition associated with hormone imbalances in women. "It's a global initiative with the intention of improving the health and the quality of life of women with PCOS and supporting their health professionals to partner with them to do so," said Helena Teede, MBBS, PhD, the lead author of the guideline as well as professor of women's health and director of the Monash Centre for Health Research and Implementation at Monash University in Melbourne, Australia.
PCOS can be hard to recognize and diagnose. While the term 'polycystic' refers to cysts on the ovaries, not every woman with PCOS will have cysts. Some women may only have a few features of the condition and these may change over time both in terms of severity and which features are expressed. Some features, such as weight gain and excess facial and body hair, can vary between ethnic groups, according to the guidelines. The variety of symptoms is one of the reasons PCOS can be difficult to diagnose. The diagnosis of PCOS can also be quite challenging in adolescents, as menstrual cycles naturally tend to vary for several months after girls have their first menstrual periods (menarche) and ultrasound characteristics are not used for diagnosis. At present, there is no specific test that can diagnose PCOS.
The main goal of the guidelines, released in July, is to standardize care for women who have PCOS. Dr. Teede says researchers will continue to study the condition and update the guidelines as needed. The new guidelines were published simultaneously in three journals: Clinical Endocrinology, Human Reproduction and Fertility and Sterility. As part of the guidelines release, a patient guide was also published to provide detailed information for girls and women with PCOS.
PCOS is the most common hormone disorder in women, affecting 13% of women worldwide, and is a leading cause of infertility in women. The condition can affect girls as young as 11 years old. It is estimated that 5 to 6 million girls and women in the U.S. have PCOS, yet many don't know they have it.
According to Professor Teede, PCOS is a multi-faceted condition, "with reproductive, metabolic and psychological features, which often means diagnosis is delayed, treatment is often not holistic and opportunities for prevention, treatment and improved health outcomes including in infertility and pregnancy health are missed."
While the exact underlying causes of PCOS are not known, there is a genetic component—women with mothers or sisters who have PCOS are twice as likely to have the condition. It is thought that the main problems are an imbalance of sex hormones and resistance to the effects of the hormone insulin, which helps regulate glucose levels in the blood. Women with PCOS may overproduce androgens such as testosterone and may experience various signs and symptoms, such as excess facial and body hair, acne, and weight gain. When there is insulin resistance, the body tries to compensate by making even more insulin. Too much insulin may cause the ovaries to increase androgen production, which in turn causes the symptoms associated with PCOS.
According to the new guidelines, a diagnosis of PCOS means a woman has two of the following three indicators:
Irregular menstrual periods—more frequent or less frequent than monthly
Symptoms such as acne (sometimes severe) and increased hair growth, which can be on the face, stomach and/or back, or a blood test showing higher levels of androgens (e.g., a testosterone test may show an elevated level)
An ultrasound of the ovaries that shows more than twenty cysts. (No ultrasound is needed if a woman has both of the first two indicators.)
PCOS is often be associated with other conditions, such as infertility, diabetes or insulin resistance, high blood pressure, heart disease and sleep apnea. While there is no cure for PCOS, treatment is aimed at reducing its symptoms and preventing further complications.
According to the new guidelines, treatment should focus on and address each woman's specific symptoms. The patient booklet addresses emotional well-being and offers a list of lifestyle changes women can make to improve their condition, including diet and exercise. There are also suggestions for treating menstrual irregularity, excess facial and body hair, acne and infertility.
Micronuclei assay in oral exfoliated buccal cells of pesticides exposed agricultural labourers in Pondicherry population
p. 153
A Aroumougam, A Santha Devy, AN Uma, N Vezhavendhan, S Vidyalakshmi, KR Premlal DOI:10.4103/srmjrds.srmjrds_74_17
Background: Occupational exposure is caused by the chemical used in pesticides that are toxic to humans and accounts for significant morbidity and mortality, especially in the developing countries. The biologically active compound present in pesticides is with various degrees of toxicity that leads to DNA damage, which, when left unattended, could lead to the process of carcinogenesis. Therefore, it is important to focus on various biometric procedures in order to evaluate the risk associated with occupational health-related issues. One among the biomonitoring test employed, the micronuclei (Mn) assay on the buccal mucosal cells is used as a part of screening in order to assess the cytotoxic status. This assay has been substantiated in the literature for the last few decades. Aims: To assess the cytotoxic damage in agricultural laborers exposed to pesticides using Mn as a biomarker. Subjects and Methods: The study involved data and sample collections from agricultural laborers (Non exposed and exposed to pesticides) by buccal smears, Papanicolaou staining and comparison of number of Mn scores as per Tolbert's and Thomas criteria, respectively. The parameters before and after exposure were analyzed by paired t-tests and partial correlation. Results: The observation of the study revealed the frequency of Mn was high in exposed individuals irrespective of age and habits when compared to that of the control group. Conclusions: In this study, as the duration of exposure increased, there was an increase in the Mn count. This indicates that there was considerable cytotoxic damage.
Effect of different chewing gums on dental plaque pH, salivary pH, and buffering capacity in children: A randomized controlled trial
p. 158
Kameshwaran Muralikrishnan, Sharath Asokan, P R Geetha Priya DOI:10.4103/srmjrds.srmjrds_45_18
Aim: The aim of this study is to evaluate and compare the changes in dental plaque pH, salivary pH, and its buffering capacity after the use of three different chewing gums for 1 month in children aged 8–12 years. Methods: This randomized controlled clinical trial consisted of 90 children with Decayed, missing, Filled teeth (dmft/DMFT) <3. They were randomly divided into three groups to receive one of the following interventions: (a) chewing gum containing xylitol, (b) chewing gum containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and (c) chewing gum containing propolis. Oral prophylaxis was done, and saliva and plaque samples were collected after 48 h as preintervention data. Participants within the experimental groups chewed gums for 10 min, two times a day for a period of 1 month. Pre-and postintervention unstimulated saliva samples were analyzed to compare the changes in dental plaque pH, saliva pH, and buffer capacity. The data were then statistically analyzed using SPSS software. Paired t-test and Student's t-test were done for mean score analysis. Results: There was a statistically significant increase in plaque pH (P = 0.001) level in all three groups. Propolis chewing gum showed an increased salivary pH level (P = 0.036). When compared between genders, girls showed a significant increase in plaque pH level in all three groups and an increase in salivary pH level in xylitol group. Conclusion: Chewing gum containing xylitol can regulate the dental plaque pH, salivary pH, and buffer capacity in a significant way than CPP-ACP and propolis chewing gum.
Feulgen stain as a special stain for mitotic figures and apoptotic bodies in oral squamous cell carcinoma
p. 164
Sankari Radhakrishnan, Ramesh Venkatapathy, PD Balamurali, Karthik Shree V Prashad, B Premalatha, Saikat Chakraborty DOI:10.4103/srmjrds.srmjrds_49_18
Background: Oral cancer is one of the most prevalent cancers worldwide. The oral squamous cell carcinoma (OSCC) is graded for the proper treatment planning, and it has been a subjective phenomenon. This grading depends on several features, of which the presence of mitotic figures and apoptotic bodies is one of the important criteria. The routine hematoxylin and eosin (H and E) staining may help in identifying the mitotic figures and apoptotic bodies, but it is difficult to identify accurately. Thus, an attempt was made to evaluate the efficacy of crystal violet and Feulgen stain in identifying the mitotic figures and apoptotic bodies and to observe any variation in different grades of carcinoma. Aims: This study was aimed at using crystal violet and Feulgen stain in identifying mitotic figures and apoptotic bodies in different grades of OSCC. Materials and Methods: Fifteen diagnosed cases of OSCC were retrieved and stained with routine H and E, crystal violet stain, and Feulgen stain. All the sections were scanned for mitotic figures and apoptotic bodies. Apoptotic index (AI) and mitotic index (MI) were calculated. AI and MI were expressed as the average of a total number of apoptotic and mitotic cells counted in ten high-power fields. Results: A significant increase in MI and AI was found in Feulgen stain than crystal violet and H and E stain. Conclusion: Feulgen stain can be considered as the best, cost-effective, relatively cheap stain to visualize mitotic figures and apoptotic bodies.
Although human oral cavity benefits from remarkable mechanical and functional properties, still it faces continuous insult and damage resulting from exposure to microbial attacks. In the past where conventional dentistry was only focused on evaluating, restoration, and replacement of the diseased oral structures. The recent era of advancement in the field of materials science, molecular biology, tissue engineering, and stem cell research's had let to the path of development of new era of periodontal engineering known as regenerative periodontics. The ultimate goal of regenerative periodontics is the regeneration of the lost periodontium due to advanced periodontal disease. Currently, scientists are working on a wide range of biomaterials and scaffolds, genes, stem cells, and growth factors in the hope of achieving more predictable outcomes in regenerative periodontics. Future research areas in regenerative periodontics include three-dimensional printing, tissue engineering, and gene therapy strategies which give more positive and predictable outcomes of regenerative periodontics. This review provides an overview of current on-going technique and researches in the field of regenerative periodontics and also will show a glimpse of what the future holds.
MM Dayakar, Prakash G Pai, Radhika Priyadarshini M Sooranagi, Vintu Vijayan, Abdul Waheed DOI:10.4103/srmjrds.srmjrds_16_18
Chemical burns on the gingiva can be caused by the use of certain pharmaceutical and nonpharmaceutical products by patients or by injudicious use of caustics by the dental clinician. These lesions in the oral cavity, however, are rarely reported. Hence, information about the product and needful instructions is necessary to be given to the patients for prevention of the same. These burns can be caused by the way of self-infliction, allergic tendency toward certain products, or it may be iatrogenic. A detailed history is the key to diagnosing and managing these cases. Chemical burns are usually treated by eliminating the etiology and managed by palliative therapy.
Pulpotomy is a procedure which involves complete amputation of the coronal pulp, followed by employment of an appropriate medicament that will stimulate healing and preserve the vitality of the tooth. This is the choice of treatment for cariously exposed vital primary molars, with formocresol considered as golden standard. However, controversies surrounding this medicament have generated inquisitiveness to exploration for natural alternatives. This narrative review is to focus on the use of natural products as alternative pulpotomy agents to formocresol so as to guide the clinicians in choosing proper medicament.
Importance of cone-beam computed tomography in dentistry: An update
p. 186
Shruthi Hegde, Vidya Ajila, Jasmine Shanti Kamath, Subhas Babu, Devika S Pillai, S Mithula Nair DOI:10.4103/srmjrds.srmjrds_26_18
In this era of advanced technology, cone-beam computed tomography (CBCT) has gained popularity in the field of oral radiology due to its advantages over conventional radiography. The use of CBCT is profoundly increasing for diagnosis and treatment planning in different specialties of dentistry. The incorporation of cone-beam technology into clinical practice is taking place because of the progress in image acquisition and three-dimensional (3D) imaging. The equipment design is easier to use, image distortion is minimal, and the images are compatible with other planning and simulation software. The 3D imaging has made the complex craniofacial structures more accessible for examination. Early and accurate diagnosis of deep-seated lesions is possible. CBCT provides a high-spatial resolution of bone and teeth which allows accurate understanding of the relationship of the adjacent structures. CBCT has helped in detecting a variety of cysts, tumors, infections, developmental anomalies, and traumatic injuries involving the maxillofacial structures. It has been used extensively for evaluating dental and osseous disease in the jaws. This paper reviews current advances in CBCT and their uses in dentistry.
Mucormycosis – Can the diagnosis be challenging at times??
p. 191
Vandana Raghunath, K Hanna Rose Priyanka, C Geetha Kiran, R Manasa Deepthi DOI:10.4103/srmjrds.srmjrds_53_18
Mucormycosis is an aggressive and often rapidly progressing fatal form of fungal infection mainly affecting the immunocompromised patients and characterized by destruction and necrosis. The paranasal sinuses get affected commonly in the rhinocerebral type with or without oral cavity involvement. At times, even in the setting of immunosuppression, it presents as a subtle clinical infection posing both as a diagnostic and therapeutic challenge to the clinicians. Further, in such immunocompromised cases, early diagnosis and prompt treatment become utmost demanding to prevent the ensuing morbidity and mortality. We present one such indolent case which presented as a sinus infection in a 50-year-old diabetic woman. Further, the granulomatous presentation on hematoxylin and eosin-stained sections led to an erroneous initial diagnosis, which later upon Grocott's methenamine silver staining was diagnosed as mucormycosis-rhinocerebral type. Thus, both clinical and histopathological presentations were defying.
Salmon calcitonin - a boon in the management of central giant cell granuloma
p. 197
D Nivethitha Gangai, G V. Murali Gopika Manoharan DOI:10.4103/srmjrds.srmjrds_50_18
Central giant cell granuloma is an uncommon, benign, proliferative lesion of unknown etiology, most commonly affecting anterior mandible of younger age group. Early diagnosis may be of benefit to the patient as conservative treatment modalities may be used as compared to radical surgical treatment. Calcitonin as a therapy for central giant cell granuloma of the jaws is a promising alternative to surgical curettage, particularly for larger lesions. We report a case of central giant cell granuloma of mandible in a 14-year-old female patient, who is being treated solely with intranasal spray of salmon calcitonin for 14 months showing greater results.
Schwannoma is a slow-growing benign tumor of the nerve sheath. It originates from the Schwann cell of the peripheral, autonomic, and cranial nerve. It is usually a single, circumscribed, firm, painless lesion of variable size. 25%–40% of all schwannomas are considered to affect the head and neck region, with the parapharyngeal space being the most common location. Only 1% of cases are intraoral. The treatment of choice is surgical excision of the tumor. Schwannomas do not show recurrence if completely excised. We report a case of schwannoma of the base of the tongue mimicking fibroma.
