Does public reporting of the detection of fetal growth restriction improve clinical outcomes: a retrospective cohort study

OBJECTIVE

To assess the impact of publicly reporting a statewide fetal growth restriction (FGR) performance indicator.

DESIGN

Retrospective cohort study from 2000 to 2017.

SETTING

All maternity services in Victoria, Australia.

POPULATION

A total of 1 231 415 singleton births at ≥32 weeks of gestation.

METHODS

We performed an interrupted time-series analysis to assess the impact of publicly reporting an FGR performance indicator on the rate of detection for severe cases of small for gestational age (SGA). Rates of perinatal mortality and morbidity and obstetric intervention were assessed for severe SGA pregnancies and pregnancies delivered for suspected SGA.

MAIN OUTCOME MEASURES

Gestation at delivery, obstetric management and perinatal outcome.

RESULTS

The public reporting of a statewide FGR performance indicator was associated with a steeper reduction per quarter in the percentage of severe SGA undelivered by 40 weeks of gestation, from 0.13 to 0.51% (P = 0.001), and a decrease in the stillbirth rate by 3.3 per 1000 births among those babies (P = 0.01). Of babies delivered for suspected SGA, the percentage with birthweights ≥ 10th centile increased from 41.4% (n = 307) in 2000 to 53.3% (n = 1597) in 2017 (P < 0.001). Admissions to a neonatal intensive care unit for babies delivered for suspected SGA but with a birthweight ≥ 10th centile increased from 0.8 to 2.0% (P < 0.001).

CONCLUSIONS

The public reporting of an FGR performance indicator has been associated with the improved detection of severe SGA and a decrease in the rate of stillbirth among those babies, but with an increase in the rate of iatrogenic birth for babies with normal growth.

TWEETABLE ABSTRACT

The public reporting of hospital performance is associated with a reduction in stillbirth, but also with unintended interventions.

Comparative evaluation of the efficacy of tricalcium phosphate, calcium sodium phosphosilicate, and casein phosphopeptide - amorphous calcium phosphate in reducing streptococcus mutans levels in saliva

BACKGROUND

There are only limited studies that have determined the antibacterial effects of various remineralizing agents that can be beneficial to children.

AIM

The aim of this study is to compare the efficacy of tricalcium phosphate (TCP), calcium sodium phosphosilicate (CSP), and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) enhanced with fluoride in reducing the Streptococcus mutans (SM) levels in saliva of children.

MATERIALS AND METHODS

Out of 245 children, 120 of them with SM colony forming units (CFU)/ml in the range of 104-106/ml of saliva were assigned to four groups: (I) TCP; (II) CSP; (III) CPP-ACP enhanced with fluoride; and (IV) control. Salivary samples were collected at intervals of 1 week, 2 weeks, and 4 weeks and the number of CFU/ml of SM in saliva were counted post 48 hour incubation.

RESULTS

After 1 week, 2 weeks, and 4 weeks, there was a significant reduction in the mean score of SM (P < 0.05). The maximum reduction in the CFU/ml in the saliva was seen in the 1st week after the commencement of the brushing in all the three test groups. Group III children demonstrated the maximum reduction of 15 × 105 CFU/ml, followed by Group II children with 10 × 105 CFU/ml.

CONCLUSIONS

Twice daily use of CPP-ACP with fluoride, CSP, and TCP caused a significant reduction in the levels of SM in saliva.

Toward accelerated bone regeneration by altering poly(D,L-lactic-co-glycolic) acid porogen content in calcium phosphate cement

This work aimed to compare in vitro degradation of dense PLGA microspheres and milled PLGA particles as porogens within CPC, considering that the manufacturing of milled PLGA is more cost-effective when compared with PLGA microspheres. Additionally, we aimed to examine the effect of porogen amount within CPC/PLGA on degradation and bone formation. Our in vitro results showed no differences between both forms of PLGA particles (as porogens in CPC; spherical for microspheres, irregular for milled) regarding morphology, porosity, and degradation. Using milled PLGA as porogens within CPC/PLGA, we evaluated the effect of porogen amount on degradation and bone forming capacity in vivo. Titanium landmarks surrounded by CPC/PLGA with 30 and 50 wt % PLGA, were implanted in forty femoral bone defects of twenty male Wistar rats. Histomorphometrical results showed a significant temporal decrease in the amount of CPC, for both formulas, and confirmed that 50 wt % PLGA degrades faster than 30 wt%, and allows for a 1.5-fold higher amount of newly formed bone. Taken together, this study demonstrated that (i) milled PLGA particles perform equal to PLGA microspheres, and (ii) tuning of the PLGA content in CPC/PLGA is a feasible approach to leverage material degradation and bone formation.

Portal vein embolization and its effect on tumour progression for colorectal cancer liver metastases

BACKGROUND

The aim of this study was to evaluate the long-term outcomes of patients with colorectal cancer liver metastasis (CRCLM) exhibiting disease progression after portal vein embolization (PVE).

METHODS

Patients with CRCLM requiring PVE before hepatectomy between 2003 and 2014 were included. Clinical variables, and liver and tumour volumes determined by three-dimensional CT volumetry were assessed before and after PVE. Overall and disease-free survival data were obtained. Univariable and multivariable logistic regression analyses were performed to identify predictors of tumour progression after PVE.

RESULTS

Of 141 patients who underwent PVE, 93 (66.0 per cent) had tumour progression and 17 (12.1 per cent) developed new contralateral lesions. Significantly fewer patients had resectable disease in the group with disease progression than among those with stable disease: 43 (46 per cent) of 93 versus 36 (75 per cent) of 48 respectively (P = 0.001). Median survival was similar in patients with and without tumour growth after PVE: 22.5 versus 26.0 months for patients with unresectable tumours (P = 0.706) and 46.2 versus 52.2 months for those with resectable disease (P = 0.953). However, disease-free survival for patients with tumour progression after PVE was shorter than that for patients with stable disease (6.0 versus 20.2 months; P = 0.045). Response to neoadjuvant chemotherapy was the only significant factor associated with tumour progression in multivariable analysis.

CONCLUSION

Tumour progression after PVE did not affect overall survival, but patients with resected tumours who had tumour growth after embolization experienced earlier recurrence. A borderline response to neoadjuvant chemotherapy seemed to be associated with tumour progression after PVE.

Influence of smoking on clinical parameters and gingival crevicular fluid volume in patients with chronic periodontitis

BACKGROUND

Tobacco smoking is regarded as one of the most significant risk factors for the development and progression of periodontal disease. In particular, studies have shown an alteration in Gingival Crevicular Fluid (GCF) volume and its components in smokers.

OBJECTIVE

The purpose of this study was to compare the GCF volume in smoking and non-smoking Saudi subjects with chronic periodontitis.

METHODS

In this study, 30 smoking patients and 30 non-smoking patients with chronic periodontitis were enrolled. Periodontal Probing Depth (PPD), Clinical Attachment Level (CAL), Plaque Index (PI), and Bleeding on Probing (BOP) were measured to assess the pattern of periodontal destruction for each patient at six sites in selected teeth. Gingival inflammation was registered at six sites, where Gingival Crevicular Fluid (GCF) was also collected. The GCF volume was measured with a Periotron 8000®. Comparisons were made between smoking and non-smoking groups with periodontitis.

RESULTS

Smokers demonstrated significantly deeper periodontal pockets (4.64±0.30 mm) than non-smokers (4.24±0.38 mm). Smoking subjects also presented significantly greater attachment loss (3.08±0.28 mm) than non-smoking subjects (2.74±0.42 mm), whereas the GCF volume was found to be significantly lower in smokers (0.25±0.04 μl) than in non-smokers (0.31±0.05 μl) (P<0.01). Among smoking subjects, lingual sites showed reduced GCF levels compared to facial sites (0.22±0.03 μl vs. 0.25±0.03 μl).

CONCLUSION

Smoking appears to have considerable adverse effects on the inflammatory process, thereby promoting the progression of periodontal disease in smokers.

CLINICAL SIGNIFICANCE

The adverse effect of smoking on the initiation and progression of periodontal disease is highlighted in this study. In particular, estimation of the GCF volume may serve as an indicator to assess the severity as well as the prognosis of periodontitis in smokers.

Gingival crevicular fluid flow rate and alkaline phosphatase level as potential marker of active tooth movement

BACKGROUND

Gingival Crevicular Fluid (GCF) changes occur during orthodontic tooth movement and this could serve as a potential indicator to the response to active treatment.

AIM

The objective of the study is to assess the changes in the GCF volume and the levels of Alkaline Phosphatase (ALP) during early phase of tooth movement.

METHODS

20 patients requiring all first premolar extractions were selected and treated with conventional straight wire mechanotherapy. Canine retraction was done using Nitinol closed coil springs. Maxillary canine on one side acted as experimental site while the contralateral canine acted as control. GCF was collected from around the canines before initiation of retraction, 1 hour after initiating canine retraction, 1 day, 7 days, 14 days and 21 days. GCF volume and the ALP levels were estimated and compared with the control side.

RESULTS

The results showed statistically significant changes in the GCF volume and ALP levels on the 7th, 14th and 21st days at the experimental sides. The peak in the activity occurred on the 14th day of initiation of retraction. The GCF volume and ALP levels did not show any significant variations at the control sites where no retraction was done.

CONCLUSIONS

It can be concluded that GCF volume and ALP levels may serve as an indicator to assess tooth movement dynamics in orthodontic therapy. Based on the available data and further studies, ALP levels in GCF may aid in developing a reliable non-invasive chair side test for assessing the prognosis and progress of orthodontic therapy.

The role of androgen receptor gene in cyclosporine induced gingival overgrowth

BACKGROUND AND OBJECTIVE

Gingival overgrowth is a prominent side effect of cyclosporine (CsA) therapy in renal transplant patients. Although the exact mechanism by which this drug induces gingival overgrowth is uncertain, marked variations in individual susceptibility to this drug suggest a genetic predisposition. Studies have shown that genetic variation (polymorphism) in the trinucleotide cytosine-adenine- guanine (CAG) sequence in exon 1 of the androgen receptor (AR) gene is related to altered activity of the AR as a transcription factor. However, the relationship between the length of the CAG repeat and gingival overgrowth has not yet been studied. The present study was carried out to determine whether there is an association between CsA-induced gingival overgrowth and the length of the CAG repeats in the AR gene.

MATERIAL AND METHODS

Genomic DNA samples were prepared from the blood of 50 renal transplant patients with CsA-induced gingival overgrowth and from the blood of 100 renal transplant patients on CsA with no gingival overgrowth.

RESULTS

The difference in allele distribution among the subjects with gingival overgrowth and control samples was statistically significant (p = 0.001).

CONCLUSION

The findings suggest a link between CsA7induced gingival overgrowth and a smaller size of CAG repeat in the AR gene.

Molecular characterization of sour orange (Citrus aurantium) accessions and their relatives using SSR and SRAP markers

Citrus production with its many varieties is of importance since it provides economically important products for Turkish exports. Sour orange is a rootstock commonly used for propagating the different scion varieties. Knowledge of the genetic diversity of the rootstock accessions would be useful in order to improve citrus breeding programs. We studied genetic relationships and diversity of 51 accessions of sour orange (Citrus aurantium) and their relatives using SSR (simple sequence repeat) and SRAP (sequence-related amplified polymorphism) molecular markers. Twenty-one SRAP primer combinations were tested on these accessions and relatives, producing 167 polymorphic fragments, with a mean of 8.0 and a mean polymorphism information content value of 0.47. Seventeen SSR primers also produced 30 polymorphic fragments, with a mean of 1.4 per primer and a mean polymorphism information content value of 0.39. The unweighted pair-group method with arithmetic average analysis using combined SSR and SRAP data showed a similarity range from 0.71 to 1.00 among the accessions. In the cluster analysis, sour orange relatives were indicated as a separate group from sour orange. 'Macrophylla' and 'Mexican lime' were the accessions most distinct (0.71) from the others. We conclude that genetic diversity in these sour orange accessions is lower and some of them were identical.

Guided bone regeneration using resorbable and non-resorbable membranes: a histological study in dogs

AIM

The aim of this study was to evaluate the effectiveness of e-PTFE titanium reinforced and Guidor membranes in the management of alveolar ridge deformities.

MATERIALS AND METHODS

Five beagle dogs were included in the study. Three through and through defects of the same size (12 x 5 x 5) were created in each animal, one on the right side and two defects 3-4 mm distant from each other on the left side. Guidor membrane was applied to the right defect, e-PTFE was applied to one of the left defects while the third defect served as control. Three, six and nine months following membrane placement, the dogs were euthanized and membranes with surrounding bone tissues harvested for histological analysis.

RESULTS

Healing in each animal was uneventful with no clinical sign of inflammation. Histological evaluation indicated the defects covered with both membranes had significantly gained greater bone formation than the control defects. On the other hand, the control defects healed thin rim of bone mostly with a persistent central defect and suprabony connective tissue invasion.

CONCLUSIONS

There were no significant differences in the bone volume surrounding the membranes in the two experimental groups. Control defects produced significantly less amount of bone when compared the membrane sites.

Studies on cryoprotectant toxicity to zebrafish (Danio rerio) ovarian tissue fragments

Cryopreservation of ovarian tissue is a viable alternative to cryopreservation of oocytes and embryos in many species but it has not been studied in fish. Selection of cryoprotectant is an important step in designing cryopreservation protocols. In order to identify the optimum cryoprotectant (CPA) in a suitable concentration for zebrafish ovarian tissue cryopreservation, studies on toxicities of five commonly used cryoprotectants methanol, ethanol, dimethyl sulfoxide (DMSO), ethylene glycol (EG) and propylene glycol (PG) were carried out. Experiments were conducted on ovarian tissue fragments consisting of stage I and stage II ovarian follicles. Ovarian tissue fragments were incubated in 90% L-15 medium (pH 9) containing 1-4M cryoprotectants for 30min at 22°C. Three different tests were used to assess ovarian tissue fragment viability: trypan blue (TB) staining, fluorescein diacetate (FDA) combined with propidium iodide (PI) staining and adenosine 5´- triphosphate (ATP) assay. Results from these tests showed that ATP assay was more sensitive than FDA+PI or TB staining for assessing cryoprotectant toxicity to follicles in tissue fragments. Methanol and ethanol were the least toxic cryoprotectants tested. Cryoprotectant toxicity increased in the order of methanol/ethanol, DMSO, PG and EG. Ethanol was used for zebrafish ovarian tissue for the first time and the results showed that the effect of methanol and ethanol on ovarian tissue fragments were comparable. As methanol has been shown to be the most effective cryoprotectant for zebrafish ovarian follicles in our laboratory, the use of ethanol will also be considered in assisting future freezing protocol design. The present study also showed that stage II ovarian follicles are more sensitive to cryoprotectant treatment than stage I follicles in tissue fragments. The results obtained in this study provided useful information for ovarian tissue fragment cryopreservation protocol design in the future.

Helicobacter pylori coinfection is a confounder, modulating mucosal inflammation in oral submucous fibrosis

The oral cavity has been considered a potential reservoir for Helicobacter pylori (H pylori) , from where the organism causes recurrent gastric infections.

AIM

With this case-control study we tried to evaluate the role of H pylori in the etiology of mucosal inflammation, a condition that compounds the morbid state associated with oral submucous fibrosis (OSF).

MATERIALS AND METHODS

Subjects ( n = 150) were selected following institutional regulations on sample collection and grouped into test cases and positive and negative controls based on the presence of mucosal fibrosis and inflammation. The negative controls had none of the clinical signs. All patients underwent an oral examination as well as tests to assess oral hygiene/periodontal disease status; a rapid urease test (RUT) of plaque samples was also done to estimate the H pylori bacterial load. We used univariate and mutivariate logistic regression for statistical analysis of the data and calculated the odds ratios to assess the risk posed by the different variables.

RESULTS

The RUT results differed significantly between the groups, reflecting the variations in the bacterial loads in each category. The test was positive in 52% in the positive controls (where nonspecific inflammation of oral mucosa was seen unassociated with fibrosis), in 46% of the test cases, and in 18% of the negative controls (healthy volunteers) (chi2 = 13.887; P < 0.01). A positive correlation was seen between the oral hygiene/periodontal disease indices and RUT reactivity in all the three groups.

CONCLUSIONS

The contribution of the H pylori in dental plaque to mucosal inflammation and periodontal disease was significant. Logistic regression analysis showed gastrointestinal disease and poor oral hygiene as being the greatest risk factors for bacterial colonization, irrespective of the subject groups. A positive correlation exists between RUT reactivity and the frequency of mucosal inflammation.

Brief exposure to antimycotics reduces the extracellular phospholipase activity of Candida albicans and Candida tropicalis

BACKGROUND

Although the phospholipase activity is considered a potential virulence determinant of the pathogenic Candida species, the effect of antimycotics on this attribute is not known. Hence we evaluated the phospholipase activity in 10 isolates each of Candida albicans and Candida tropicalis, after their exposure to antifungals.

METHODS

The impact of antimycotics on phospholipase activity was also assessed after exposure of the isolates to sub-minimum inhibitory concentrations of nystatin, amphotericin B and fluconazole.

RESULTS

All Candida isolates investigated exhibited phospholipase activity (Pz). In general C. ALBICANS showed relatively higher P(z) activity than C. tropicalis , and exposure of the isolates to antimycotics led to a significant (p < 0.05) reduction in the phospholipase activity. Nystatin and amphotericin B, but not fluconazole, significantly reduced the phospholipase activity of both Candida species.

CONCLUSION

These observations, while confirming the higher virulence of C. albicans relative to C. tropicalis, demonstrate for the first time the effect of antifungal agents on extracellular phospholipases of these common opportunistic pathogens.

Adhesion and cell-surface-hydrophobicity of sequentially isolated genetic isotypes of Candida albicans in an HIV-infected Southern Chinese cohort. Adharenz und Zelloberflachen-Hydrophobizitat von sequentiell isolierten genetischen Isotypen von Candida albicans aus einer HIV-infizierten sudchinesischen Kohorte

Objectives of the study were to investigate the variability in yeast adhesion and cell-surface-hydrophobicity (CSH) during human immunodeficiency virus (HIV) disease progression, using a total of 60 sequential Candida albicans isolated from oral rinse samples of seven HIV-infected individuals with (4) and without (3) clinical symptoms of oropharyngeal candidosis. Significant differences in the adhesion to buccal epithelial cells (BECs) during sequential visits were observed for all genetic isotypes in five of the seven individuals and three isotypes belonging to the sixth individual. A single isotype of patient HK1 and another of HK4 (genotype I) demonstrated significant variations in their CSH during sequential visits whereas no such differences were noted for the remaining genotypes. On Spearman correlation analysis an isotype from HK1 demonstrated a significant increased adherence to BECs and CSH during HIV disease progression whereas no such correlation was noted for the remaining isotypes studied. No significant differences in adherence to BECs or CSH values were observed between the symptomatic oral candidosis and the asymptomatic carrier group. Further, on regression analysis only the single isotype of HK1 demonstrated a significant positive correlation between adherence to BECs and CSH whereas no such correlation was observed when all tested Candida isolates were pooled and evaluated as a single, large group.

Phenotypic diversity of oral C. albicans isolated on single and sequential visits in an HIV-infected Chinese cohort

HIV-infected individuals maintain multiple oral C. albicans strains over time that are thought to undergo microevolution in terms of both phenotypic and genotypic features. To study this phenomenon, a 12-month prospective study was conducted in a cohort of 16 HIV-infected ethnic Chinese individuals with (A) and without (B) symptoms of oropharyngeal candidiasis to evaluate the phenotype distribution among oral C. albicans isolates during disease progression. Oral rinse samples were obtained and up to five C. albicans colony-forming units were selected per each visit, during the one year period of multiple visits. The isolates were phenotyped using two commercially available biotyping kits, the API 20C system, API ZYM system, and a plate test for resistance to boric acid. A total of 261 C. albicans strains in group A were differentiated into 67 biotypes, while 42 biotypes were seen amongst the 182 isolates from group B. The major biotypes in the two groups were similar and were in decreasing order of prevalence J1R, J1S, J6S, J6R, J2S, K1S, J10R, K1R, and K6R; 48 different biotypes were seen in group A and 24 in group B, with some uniquely represented in each group, leading to a significant association between the prevalence of the biotypes J1S and J2S and symptomatic candidiasis (p<0.05). Taken together this study illustrates the wide phenotypic spectrum of oral C. albicans associated with HIV-infection.

The impact of polyene, azole, and DNA analogue antimycotics on the cell surface hydrophobicity of Candida albicans and Candida tropicalis in HIV infection

Oral candidiasis is the most common opportunistic infection in individuals infected with the human immunodeficiency virus. Though Candida albicans is the major aetiological agent, non-albicans species such Candida tropicalis are now emerging as important agents of such infection. The Candida cell surface hydrophobicity (CSH) is considered a critical factor contributing to its colonization potential and virulence. It is also known that brief exposure to sub-cidal concentrations of antifungal agents is a likely scenario in the oral environment where the administered drugs are diluted continuously due to the flushing action of saliva. Hence the objective of the present study was to compare the CSH of 10 isolates each of C. albicans and C. tropicalis from HIV-infected individuals following brief exposure (1 hour) of isolates to sub-therapeutic concentrations of nystatin, amphotericin B, ketoconazole, fluconazole and 5-flurocytosine. The CSH was assessed by a previously described biphasic aqueous-hydrocarbon assay. The mean percentage reduction of CSH of C. albicans following brief exposure to nystatin, amphotericin B, ketoconazole, fluconazole and 5-flurocytosine was 27.33 (p < 0.001), 21.34 (p < 0.05), 11.74 (p > 0.05), 18.4 (p > 0.05) and 14.64 (p > 0.05) respectively. The mean percentage reduction of CSH of C. tropicalis following brief exposure to nystatin, amphotericin B, ketoconazole, fluconazole and 5-flurocytosine was 33.81 (p < 0.01), 28.88 (p < 0.01), 12.6 (p > 0.05), 21.53 (p > 0.05) and 17.68 (p > 0.05) respectively. A significant interspecies variation in CSH was observed for nystatin and amphoterecin B. Overall the results reveal that the CSH of C. albicans is affected to a significantly lesser degree compared with C. tropicalis when exposed to the antifungals. These data further illustrate another mode of action of antifungals on Candida leading to a reduction in the CSH and thereby the yeast adherence to host tissues.

Impact of lysozyme and lactoferrin on oral Candida isolates exposed to polyene antimycotics and fluconazole

OBJECTIVE

To assess the antifungal activity of lysozyme and lactoferrin on 10 oral isolates each of Candida albicans and Candida tropicalis following their brief exposure (I h) to subtherapeutic concentrations of two polyene drugs - nystatin, amphotericin B, and an azole -fluconazole.

METHODS

Yeasts were sequentially exposed to subtherapeutic concentrations of antifungals and then to either lysozyme or lactoferrin and the viability evaluated by quantifying colony-forming units.

RESULTS

The exposure of both C. albicans and C. tropicalis isolates to all three antifungal agents significantly increased their susceptibility to lysozyme (P < 0.05) but not to lactoferrin. Exposure to the two polyene drugs had a lesser impact on the lysozyme susceptibility of both Candida species compared with the azole drug. Both interspecies and intraspecies sensitivity to lysozyme was noted and C. albicans was less susceptible than C. tropicalis.

CONCLUSIONS

Lysozyme, in addition to being a potent natural antifungal agent, may act synergistically with the studied antimycotics.

Post-antifungal effect of polyene, azole and DNA-analogue agents against oral Candida albicans and Candida tropicalis isolates in HIV disease

Oropharyngeal candidiasis (OPC) is the most frequent AIDS-associated opportunistic infection, as up to 90% of HIV-infected individuals suffer at least one episode during the course of their disease. Various in vivo and in vitro procedures have been used to assess the effectiveness of antifungal agents used in HIV infection. In the present study, we evaluated in vitro the minimum inhibitory concentration (MIC) and the post-antifungal effect (PAFE) of two polyenes, two azoles and one DNA-analogue against 10 oral isolates of Candida albicans and 10 of Candida tropicalis, all from HIV-infected individuals, in order to obtain basic data on the pharmacodynamics of these drugs. One-hour exposure to twice the MIC of all the drugs, except fluconazole, elicited a consistently high PAFE in both Candida species. Furthermore, the PAFE elicited by the antifungals (except fluconazole) was significantly prolonged for C. tropicalis compared with C. albicans. This speedy recovery of C. albicans isolates exposed to transient low concentrations of antifungals appeared to reflect its virulence compared with lesser potent species, such as C. tropicalis. Taken together, the current data, while confirming the existence of PAFE in a non-albicans species of Candida, also provide further clues for the recalcitrance of C. albicans species in the face of antifungal therapy for oropharyngeal candidiasis.

The impact of chlorhexidine gluconate on the relative cell surface hydrophobicity of oral Candida albicans

OBJECTIVES

Adherence of Candida albicans has been implicated as the first step in the pathogenesis of oral candidosis, and its relative cell surface hydrophobicity (CSH) a contributory physical force. Chlorhexidine gluconate is by far the commonest antiseptic mouthwash prescribed in dentistry. The intra-oral concentrations of the retained chlorhexidine mouthwash fluctuate considerably due to the dilution effect of saliva and the cleansing action of the oral musculature. Hence the objective of the present study was to investigate the effect of brief exposure to sub-therapeutic concentrations of chlorhexidine gluconate on the relative CSH of C. albicans.

DESIGN

The CSH of the isolates was assessed by a biphasic aqueous-hydrocarbon assay.

RESULTS

A statistically significant reduction in CSH was observed following the exposure of Candida isolates to 0.005 and 0.0025% chlorhexidine gluconate.

CONCLUSIONS

These results elucidate additional mechanisms by which chlorhexidine gluconate suppress candidal pathogenicity despite a brief period of transient exposure within the oral environment.

The effect of oral bacteria on Candida albicans germ-tube formation

A total of eight bacterial isolates belonging to six species, and a select group of 12 oral Candida albicans isolates, were used to study the effect of bacteria on germ-tube formation. Briefly, each bacterial suspension (10(5-6) cells/ml) was mixed with a C. albicans suspension (10(7) cells/ml) and incubated at 37 degrees C for 90 min with bovine serum, and the percentage germ-tube-positive Candida cells was quantified using a haemocytometer, under light microscopy. In general, out of eight bacteria, Streptococcus sanguis SK21A, Streptococcus salivarius SK56, Escherichia coli ATCC 25922, and S. salivarius OBU3 suppressed germ-tube formation to varying degrees, with different C albicans isolates. Porphyromonas gingivalis Pg 50, Lactobacillus casei ATCC 7469 and Prevotella intermedia OBU4 elicited significant enhancement of germ-tube formation, whereas S. sanguis OBU 2 had no effect. E. coli ATCC 25922 was the only organism to show statistically significant suppression of germ-tube formation (p=0.0312). A significant increase in the germ tube production of C. albicans isolated from HIV-infected compared with HIV-free individuals was also noted. The current results tend to suggest that commensal and transient oral bacterial populations may selectively influence the differential expression of germ-tube-forming ability of C. albicans isolates.

Tuberculous ulcer of the tongue as presenting feature of pulmonary tuberculosis and HIV infection

Tuberculosis (TB), once a lethal disease, has shown a decrease in incidence with improved public health measures and availability of antituberculous drugs. But with the advent of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), it has re-emerged alarmingly as an opportunistic infection in immunocompromised patients. Lungs are the most commonly affected organs and involvement of the oropharyngeal region in TB is very rare. Two cases of TB manifesting as ulcer of the tongue are reported here. Interestingly, both of these cases were reported within a span of six months and both of the patients were in their early thirties. A primary diagnosis of both pulmonary TB and HIV sero-positivity was made after the diagnosis of the oral TB ulcer.

Metastasis of thyroid carcinoma to the mandible. Case report

Metastatic tumours to the jaw bones are uncommon. The incidence of jaw bone metastasis is difficult to assess accurately since the usual method to determine the distribution of a metastatic tumour has been by a radiographic skeletal survey in which the jaws are rarely included. At times, metastatic lesions of the orofacial region may be the first evidence of dissemination of a known tumour from its primary site. A case of metastatic follicular carcinoma of the thyroid to the mandible is presented. The present case emphasizes the importance of considering metastasis in the differential diagnosis of a radiolucent lesion in the mandible in a patient with a history of any malignant disease.

Current research in diagnostic methods for assessing periodontal disease

The management of chronic periodontal disease is beset with a numbers of diagnostic as well as therapeutic problems. Assessment of periodontal disease progression has been made mainly based on the conventional methods such as clinical parameters and radiographic interpretation. A high level interest in the development of diagnostic tests capable of detecting factors associated with progressing periodontal disease has continued in the past years. Recent research has shown evidence that certain microbial species and specific genetic and related factors are some strong indicators of susceptibility to severe periodontitis. Here an attempt is made to review the current trends and diagnostic tests used to assess the disease activity and predict its progression.

Expression of lectin binding in oral submucous fibrosis

Lectins are a group of specific glycoproteins present in cells, particularly cell membrane. Recently, lectin binding studies have been used as a diagnostic as well as prognostic indicator of neoplasm's. Oral submucous fibrosis (OSMF) is a potential premalignant condition predominantly seen in Indian subcontinent. A comparison of expression of lectin binding was studied in normal tissue, OSMF cases and oral squamous cell carcinoma. The OSMF cases were grouped into early and advanced conditions as per the histopathologic criteria. Patterns of lectin binding observed with advanced OSMF cases were comparable with that of Oral squamous cell carcinoma. The role of lectin binding studies in assessing the malignant potential of a pre-malignant condition is discussed.

Chondrosarcoma of the maxilla. Case report

Chondrosarcoma is a rare malignant neoplasm of the jaws. The diagnosis of this lesion is mainly based on the histopathological appearance. A case of chondrosarcoma of the maxilla is reported. The origin of this rare tumor in the maxilla, a bone with exclusive membranous ossification, is discussed.

Oral lesions of HIV and AIDS in Asia: an overview

The magnitude of HIV infection in the Asian region is increasing dramatically. Oral disease represents an important health problem for HIV-infected individuals, because of its diagnostic, prognostic and therapeutic implications. The documentation and reporting of HIV infection and AIDS in most of the Asian countries has been superficial. Though the epidemiology of HIV infection in Asia has been studied by many investigators, few attempts have been made to summarise the data and assess the magnitude of the problem, the mode of transmission, the spread of infection and clinical pattern of illness. A review of the literature shows that there is hardly any published data on oral manifestations of HIV infection or AIDS from the Asian region. However, some preliminary information is available on the type of lesion presenting in patients from India and Thailand. These observations suggest that oral manifestations are common in HIV-infected and AIDS patients. The pattern of occurrence of various lesions reported appears to show variation from those reports from other parts of the world, but no definitive conclusion can be drawn from these preliminary observations. Further epidemiological studies are necessary to substantiate the present understanding of the nature of oral lesions found in Asian countries.

Squamous cell carcinoma of the gingiva in an HIV-positive patient: a case report

This article presents a case of gingival squamous cell carcinoma in a patient who was HIV positive but who had no history of pan chewing, smoking, alcohol consumption or nutritional deficiency. Investigations also revealed the presence of superimposed pseudomembranous candidiasis. The case reported reveals that squamous cell carcinoma of the gingiva may occur as an oral manifestation of AIDS.

Gingival enlargement as a diagnostic indicator in leukaemia. Case report

The acute leukaemias are a group of neoplastic diseases that are characterized by proliferation of immature white cells in the bone marrow and/or blood and are often associated with severe leukopenia, anaemia and thrombocytopenia. Oral manifestations are more common in patients with acute leukaemia. Oral bleeding, gingival enlargement, ulceration and infection in patients with leukaemia have been described. Leukaemic infiltrates in the gingivae are commonly seen in acute monocytic leukaemia. A case of acute monocytic leukaemia in a 34-year-old female who reported with gingival enlargement is presented here. The role of oral lesions as a diagnostic indicator is discussed.

Detection of HIV antibodies in saliva and its implications

Human immunodeficiency virus has been detected in almost all body fluids. With a silent disease such as HIV infection, testing for HIV antibodies currently is the most cost effective means for determining the incidence and prevalence of HIV infection in the community and for identifying HIV infection in the individuals. HIV antibodies are found in human saliva and can be detected by sensitive ELISA. Saliva collection is easy to perform, non-invasive, safe to use and thus provides alternative method to blood collection. Research is underway to develop a low-cost saliva assay, thus saliva could become the HIV antibody testing medium of choice for much of the developing countries.

Evaluation of serum beta 2-microglobulin in premalignant and malignant lesions of the oral cavity

Serum beta-2-microglobulin was estimated in patients with oral leukoplakia, oral submucous fibrosis, and oral cancer. The results were compared with that of an equal number of age- and sex-matched healthy controls. A definite increase in the level of beta 2-microglobulin was observed in patients with oral submucous fibrosis and oral cancer. Though the level of beta 2-microglobulin was found to be high in oral leukoplakia, it was not statistically significant. Further studies will validate the role of beta 2-microglobulin estimation to predict the malignant potential of oral submucous fibrosis.

Mandibulofacial dysostosis. Case report

A case of mandibulofacial dysostosis (Treacher Collins syndrome) is presented. Clinical features and skull radiographs revealed typical anomalies associated with the syndrome. Cleft of the soft palate and unerupted multiple supernumerary teeth were present in this case. No haematological, biochemical or immunological abnormalities could be detected in the patient. Pedigree analysis showed an autosomal dominant mode of transmission of the disease. Chromosomal studies did not reveal any structural or numerical discrepancies.

Hyalinosis cutis et mucosae--a case report

Hyalinosis cutis et mucosae is a rare genetic disease characterized by accumulation of glycoproteinaceous material at mucocutaneous sites, salivary glands, central and peripheral nervous systems, eyes, other organs and tissues. The course of the disease is protracted and not likely to regress either spontaneously or with therapy. The disease may produce considerable disfigurement and functional impairment. The morbid factors include disfiguring papulonodular lesions particularly of expose skin, hoarseness of voice due to vocal cord. Infiltration, nodular deformation of the eyelids and board like rigidity of tongue. A case of Hyalinosis cutis et mucosae in a 18 year old girl is reported here. The clinical features, histopathology and management are discussed in detail.

Quantitation of circulating immune complexes in patients with chronic periapical lesions

Quantitation of circulating immune complexes (CIC) was done in 45 patients with chronic periapical lesions. The levels were compared with those of age-matched healthy individuals. Both patients with chronic periapical granuloma and periapical cysts showed significantly higher levels of CIC than the controls. This observation indicates that the continuous presence of root canal antigens may cause elevated levels of circulating immune complexes. The possibility of chronic periapical lesions acting as foci of infection is discussed, and the importance of early treatment of these conditions is emphasized.

Fracture of tooth by internal resorption: case report

A case of extensive internal resorption of the left mandibular first premolar in a 24 year old man is reported. The case presented with slight discolouration and mobility of the tooth. On radiological examination extensive internal resorption and a fracture line at the cemento enamel region was observed, separating the crown and root. The case was treated endodontically after surgical removal of the fractured fragment of the crown.

Melanotic neuroectodermal tumor of infancy. Report of a case

A case of melanotic neuroectodermal tumor of infancy involving the right maxillary alveolar ridge region of a 4 month old girl is reported. Clinical, histopathological and laboratory findings supported the diagnosis. This case had high levels of urinary excretion of vanilmandelic acid (2.8 mg/24 hrs.) and serum alpha-fetoprotein (210 mg/ml); which are characteristic of this tumor.

Oral submucous fibrosis in a 12-year-old girl: case report

A case of oral submucous fibrosis in a 12-year-old girl discusses its etiopathogenesis, clinical features, and histopathologic findings of the condition and highlights strong association of areca nut chewing as the potential factor in the etiology of this condition. Cessation of the areca nut chewing habit and submucosal administration of aqueous extract of healthy human placental extract (Placentrex) showed marked improvement of the condition. (Pediatr Dent 15:120-22, 1993).

Total hemolytic complement (CH50) and its fractions C3 and C4 in the sera of patients with localized juvenile periodontitis

The total hemolytic complement activity (CH50) and its fractions C3 and C4 levels were determined in the sera of 21 subjects with localized juvenile periodontitis (LJP). Total hemolytic complement activity was expressed as number of CH50 units per ml of blood, while C3 and C4 levels were assessed by radial immunodiffusion and expressed as mg%. The values were compared with an equal number of age- and sex-matched periodontally healthy controls. The results indicate a significant increase in CH50, C3, and C4 levels in the sera of patients with LJP. The study reveals the participation of complement system in the pathogenesis of LJP, and its assessment may assist in understanding the relative importance of complement activities in the disease process.

Immunology of chronic generalized periodontitis. 2. Estimation of total hemolytic complement (CH 50) and its fractions C3 and C4

The total hemolytic complement activity (CH50) and its fractions C3 and C4 were determined in forty patients with chronic generalized periodontitis (CGP). The values were compared with an equal number of age and sex matched periodontally healthy controls. Total hemolytic complement activity was expressed as number of CH50 units per ml of blood, while C3 and C4 levels were assessed by radial immunodiffusion and expressed as mg%. The observations showed a significant increase in CH50, C3 and C4 levels in the sera of patients with CGP. The study reveals the role of complement system in the pathogenesis of chronic generalized periodontitis.

Plant lectins--histochemical and cytochemical applications in oncology

Lectins are sugar binding proteins or glycoproteins of non-immune origin derived from various plants or animals with specific sugar binding capacity. This property of lectins can be used to identify structural differences between normal and malignant cells. Malignant transformation is accompanied by several changes in cell membrane. Studies have shown that the lectin binding pattern of these cells may indicate the invasive potential of tumours. Lectins can also be used as carriers. Lectins conjugated to chemotherapeutic agents has been found to be more useful in the treatment of tumours induced in animals.

Circulating immune complexes in localised juvenile periodontitis

This study determined the quantity and type of circulating immune complexes (CIC) in the sera of 15 patients with localised juvenile periodontitis (LJP). There was a significantly higher level IgG and IgM in LJP patients as compared with the controls. The possible role of CIC in the pathogenesis of juvenile periodontitis is discussed.