Dental professional's perspective regarding knowledge, awareness, and attitude towards the importance of charting dental anomalies: a cross-sectional study

OBJECTIVES

The presence of dental anomalies could play a significant role in the identification of individuals by comparing antemortem and postmortem data. This cross-sectional study aimed to assess the level of knowledge, attitude, and awareness among dental professionals regarding the importance of charting dental anomalies and maintaining dental records.

METHODOLOGY

A self-structured questionnaire was e-mailed to dental professionals practicing in India. The responses were recorded, data tabulated, and one-way ANOVA and post hoc tests were applied for analysis. The criterion for significance was p < .05.

RESULTS

A total of 406 dental professionals responded to the survey. A significant difference was observed in the mean attitude score of participants towards the importance of charting dental anomalies and maintaining dental records with regard to place of work (p=.001), gender (p=.044) and educational qualification (p=.039). In addition, a statistically significant difference was observed in the mean awareness score of participants with respect to place of work (p=.033) and gender (p=.001). The major barriers in maintaining dental records were lack of time, adequate knowledge, infrastructure, and financial constraints.

CONCLUSION

81.3% and 69.26% study participants had very good awareness and attitude, whereas 71.2% had good knowledge regarding the importance of charting dental anomalies and maintenance of dental records; however, their inaccurate responses in anomaly identification hinted towards the need for proper dental charting and their maintenance to be taught en masse and made part of the BDS curriculum.

Knowledge, awareness and attitude of dental professionals regarding child maltreatment

BACKGROUND

Dental professionals could play a significant role in identifying, documenting and reporting child maltreatment to appropriate authorities as children are exposed to various maltreatments that can present in the head and neck region.

AIM

The aim of this paper is to assess the level of knowledge, awareness and attitude among dental professionals regarding child maltreatment and to identify the barriers that prevent reporting suspected maltreatment.

METHODOLOGY

The present cross-sectional questionnaire-based study was conducted on dental professionals practising in India by emailing a self-structured questionnaire to assess knowledge, awareness and attitude regarding child maltreatment.

RESULTS

422 dental professionals participated in the survey of which 270 were females. A significant difference was observed in mean knowledge (p=.015), awareness (p=.014) score of the participants with regard to place of work and mean knowledge score (p=.024) of the participants with regard to educational qualification. 300 participants reported that lack of adequate knowledge and awareness about the role of dental professionals regarding child maltreatment is one of the major barriers that prevent reporting child maltreatment.

CONCLUSION

Findings of the study showed that 43.8% of participants had good knowledge and 44.8% were fairly aware regarding child maltreatment. 86.7% of participants showed a very good attitude towards learning more about the role of dental professionals in the management of child maltreatment.

Immunohistochemical evaluation of cyclooxygenase-2 and mast cell density in periapical lesions

AIM

Periapical granuloma (PG) and cyst (PC) are formed as a protective response consequent to pulpal infection leaching through the apical foramen and lateral canals. Various inflammatory mediators like mast cells and cyclooxygenase (COX)-2 are involved in this intricate process. This pilot study aimed to evaluate and compare the immunoexpression of tryptase and COX-2 in periapical granuloma and periapical cyst, and also correlate them with intensity of inflammatory infiltrate and thickness of cystic epithelial lining.

METHODOLOGY

An observational and cross-sectional study was conducted on paraffin-embedded tissue sections of 50 PGs and 50 PCs submitted for morphological and immunohistochemical analysis using anti-tryptase and anti-COX-2 antibodies. The mean number of mast cells (total, granulated & degranulated), mean COX-2 expression and inflammatory score was calculated. The data obtained were analyzed using Mann Whitney U, Student's T, Chi-square and Spearman correlation test (P < 0.05).

RESULTS

The inflammatory score, total mast cells and COX-2 expression were similar in PGs and PCs (P= 0.352, 0.339 and 0.352) however, the degranulated mast cells were highly significant in PC while granulated mast cells were highly significant in PG respectively (P<0.001 in both). Although a non-significant correlation existed between COX-2 and total mast cells in both groups but, total mast cells were significantly correlated with epithelial thickness in PC (P= 0.029).

CONCLUSIONS

Mast cells and cyclooxygenase-2 proved to be independent inflammatory markers in periapical lesions. Further studies should be planned on mast cell and COX-2 inhibitors as treatment modalities of periapical lesions.

Mucormycosis infection associated with global COVID-19 pandemic - an institutional histopathological study

BACKGROUND

Coronavirus disease 2019 (COVID-19) in the recent times have instilled signs of immunosuppression globally which has further precipitated increasing range of opportunistic infections. Mucormycosis is a distressing opportunistic fungal infection with a high incidence and is the third commonest acute invasive infection following candidiasis and aspergillosis. The aim of the present observational study is to delineate the enigmatic histopathological profile between mucormycosis cases seen prior to pandemic (PPM) and pandemic associated mucormycosis (PAM).

MATERIAL AND METHODS

Tissue archives of 105 histopathologically diagnosed cases of mucormycosis were included and analysed for demographical details and histopathological parameters like fungal load and localization, granuloma formation, necrosis, inflammatory infiltrate and tissue invasion.

RESULTS

0ut of 105 included cases, 11/105 (10.48%) were reported PPM and 94/105 (89.52%) PAM. Among 94 cases of PAM, 51/94 (54%) cases also showed COVID-19 positivity, while 43/94 (46%) did not. Of all the histological variables, increased fungal load and necrosis were observed in PAM relative to PPM cases.

CONCLUSIONS

The histopathological variables like fungal load, necrosis, granuloma formation and tissue invasion, could help the clinician in assessing the clinical status at the time of tissue diagnosis and improve the treatment accordingly.

Isolated lymph node recurrence in epithelial ovarian cancer - management and outcome

INTRODUCTION

The aim of our study was to assess the clinical outcome of isolated lymph node recurrence in patients with epithelial ovarian cancer treated by surgery and to analyze the impact of various clinico-pathological factors on prognosis.

MATERIAL AND METHODS

We conducted a retrospective analysis of all the epithelial ovarian cancer patients who underwent secondary lymphadenectomy surgery for isolated lymph node recurrence at our institute from 2013 to 2020. Univariate analysis of various factors influencing the post-recurrence disease free survival and post-recurrence survival was done using Kaplan-Meier for categorical variables and cox-proportional hazard progression for continuous variables.

RESULTS

A total of 21 patients of isolated lymph node recurrence were treated surgically during the study period. The median disease free interval to develop lymph nodal recurrence was 13 months. All the patients achieved complete resection to no gross residual disease without any significant morbidity associated with the procedure. The median post-recurrence disease free survival after treatment of lymph node recurrence was 25 months with 3-year post-recurrence survival of 72% and 3-year overall survival of 85%. Amongst the factors influencing post-recurrence disease free survival, young age (< 50 years), para-aortic lymph node dissection at initial surgery and single site of lymph node recurrence were significantly associated with better prognosis. A single site of lymph node recurrence was associated with significantly better post-recurrence survival.

CONCLUSIONS

Complete resection is feasible for epithelial ovarian cancer patients presenting with isolated lymph node recurrence, without any significant perioperative morbidity. When combined with postoperative adjuvant chemotherapy, complete resection is associated with favourable survival outcomes. Young age, para-aortic lymph node dissection during primary surgery and single site of lymph node recurrence are associated with better prognosis.

Genotypic correlation between post discharge Clostridiodes difficle infection (CDI) and previous unit-based contacts

BACKGROUND

Cases of Clostridiodes difficile infection (CDI) diagnosed after hospital discharge account for a substantial proportion of new infections. It is unclear whether post-discharge infections originate from hospital-based transmission.

METHODS

This was a Retrospective cohort study at a tertiary-care cancer center (non-outbreak setting). For all laboratory-identified cases of CDI in 2015-2016, patients with post-discharge (PD) CDI within eight weeks of their hospital stay were included in the study. Isolates from PD-CDI cases and their CDI-positive unit-based contacts were first genotyped by multilocus sequence typing (MLST). Common strains were further examined by core genome sequencing (CGS) to evaluate transmission links.

RESULTS

Of 173 cases examined by MLST, 50% of PD cases matched previous unit contacts. Next, 34 isolates, including 16 PD cases and their 18-unit contacts were examined by CGS. None were ≤3 single-nucleotide variants apart. Seventy percent of PD cases had in-hospital antibiotic exposure before CDI onset in the community.

CONCLUSION

Our study results suggest that symptomatic CDI cases are not a substantial source of transmission to PD cases. Frequent antibiotic exposure in post-discharge CDI cases is an important target for surveillance and stewardship efforts.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Primary uterine angiosarcoma with "rhabdoid morphology": A case report

INTRODUCTION

Primary uterine angiosarcoma is a very rare tumour, with only 23 cases described till now. It is a malignant tumour with cells variably recapitulating the morphologic features of an endothelium and expressing immunohistochemical markers of endothelial cells. In general, it is a bulky neoplasm and frequently is at advance stage of disease at presentation. In general, patients with uterine angiosarcoma tend to have a poorer prognosis, mostly related to the aggressive nature and the metastatic potential of these tumours.

CASE REPORT

We report a rare case of primary uterine angiosarcoma with unusual rhabdoid morphology in a 41-year-old female, who underwent radical hysterectomy and died of disease after 4 months of treatment.

DISCUSSION

We described the differential diagnosis of primary angiosarcoma of the uterus that can pose a diagnostic challenge.

Bilateral fusion of permanent mandibular incisors: a case report

This case report showing a classical presentation of bilateral fusion of permanent mandibular incisors in a child patient for dental attention. Fusion defined as the merger of two adjacent tooth germs producing one tooth. These teeth may be fused by enamel, dentin, or both. The fused crown is broader than non fused adjacent teeth and thus resembles gemination. However, tooth counting reveals decreased numbers. Fused teeth are rare in the permanent dentition. The incisors are reported to be fused in primary and permanent dentition, but bilateral fusion is a rare occurrence. Hence the case report of bilateral fusion in an 11-year-old boy is presented.

Work-up for infectious diarrhea after allogeneic hematopoietic stem cell transplantation: single specimen testing results in cost savings without compromising diagnostic yield

BACKGROUND

Diarrhea is a common complication of allogeneic bone marrow transplantation. Microbiologic stool studies are frequently ordered to rule out infectious etiology. The utility of examining multiple stool specimens per diarrheal episode has not been examined.

METHODS

. We performed a retrospective review of 169 adult and pediatric patients who underwent hematopoietic stem cell transplantation at Memorial Sloan-Kettering Cancer Center from January 1, 2000 though December 31, 2001, who had at least 1 microbiologic stool study. We report on the incidence of enteric pathogens in our population and diagnostic yield of stool studies. A diarrheal episode was defined as a 14-day period from the date of the first stool study. Cost savings analysis was based on projected savings from implementation of proposed guidelines to the study population.

RESULTS

A total of 1649 stool tests were performed (mean 10.6 tests per patient). An infectious cause of diarrhea was found in 45 (28.8%) patients. Diagnostic yield was 6.2% for Clostridum difficile toxin assay, 12.9% for viral cultures, and 1.3% for rotavirus enzyme immunoassay. Bacterial cultures for enteric pathogens, examination for parasites, and rotavirus antigen assay combined had 0.5% positive yield.

CONCLUSIONS

Testing of multiple specimens per diarrheal episode did not increase diagnostic yield. The estimated cost savings by implementing single testing for each type of stool study per diarrheal episode was $49,764 annually (in 2001 US dollars). Judicious use of stool tests to evaluate diarrhea results in significant cost savings without compromising diagnostic yield.

Tacrolimus (Pan Graf) in Live Related Renal Transplantation: An Initial Experience of 101 Recipients in India

BACKGROUND

Success of modern transplantation is in large part due to the successful development of effective immunosuppressive agents. The safety and efficacy of tacrolimus in transplantation is well established. However, tacrolimus (Pan Graf, Panacea Biotec Ltd, India) has only been available in India for the last 2 years. This study was conducted to assess the safety and efficacy of tacrolimus in live related kidney transplantation. We report an initial experience of tacrolimus as de novo therapy in a live related renal transplantation program.

MATERIALS AND METHODS

One hundred one consecutive recipients of a live renal allograft were commenced on triple immunosuppression consisting of tacrolimus, mycophenolate mofetil or azathioprine, and steroids. The dose of tacrolimus was adjusted to keep trough levels at 10-12 ng/mL in the first 3 months, 8-10 ng/mL in the next 3 months, and 5-8 ng/mL thereafter. All patients were followed up for a period ranging from 4 weeks to 24 months. The effect of this regimen on the incidence of graft rejection, graft survival, patient survival, and new-onset diabetes mellitus was evaluated. Any evidence of graft dysfunction was evaluated using a graft biopsy.

RESULTS

There were 89 male and 12 female patients with mean age of 32.08 years. The incidence of acute rejection was 3.96%; 21.05% developed new-onset diabetes mellitus. Six patients were diabetic prior to transplantation and 9 patients were hepatitis C virus (HCV)-positive; 77.7% of HCV-positive patients and 15.1% of HCV-negative patients developed posttransplantation diabetes mellitus. The patient survival rate at the current follow-up was 92.07%. No graft was lost due to rejection.

CONCLUSION

Tacrolimus is a safe and effective immunosuppressant in live related renal transplantation.

Tacrolimus (Pan Graf) as de Novo Therapy in Renal Transplant Recpients in India

The safety and efficacy of tacrolimus in transplantation is well established. However, tacrolimus has only recently been available in India. We report an initial experience using tacrolimus as de novo therapy in a living related renal transplant program. Fifty-two consecutive recipients of living renal allografts were treated with tacrolimus, mycophenolate mofetil, or azathioprine and steroids. The dose of tacrolimus was adjusted to keep trough levels at 10 to 12 ng/mL in the first 3 months, 8 to 10 ng/mL in the next 3 months, and 5 to 8 ng/mL thereafter. Any evidence of graft dysfunction was evaluated by graft biopsy. The effect of this regimen on the lipid profile as well as the incidence of posttransplant diabetes mellitus was evaluated in an Indian population. All patients were followed for periods ranging from 6 to 72 weeks (mean = 29 weeks). The incidence of acute rejection was 3.84%; 17.3% developed posttransplant diabetes mellitus. Graft and patient survivals at the current follow-up were 100% and 96.26%. In conclusion, tacrolimus is a safe and effective immunosuppressant in a living related renal transplant program.

Rhodococcus equi brain abscess in a patient without HIV

Rhodococcus equi, a Gram positive organism, is a cause of infections in immunocompromised individuals. In humans, it mainly causes disease in those infected with human immunodeficiency virus (HIV), and generally presents as chronic pulmonary infection. It may also cause intracranial infections, which manifest as brain abscesses. This report describes a case of rhodococcus brain and pulmonary infection in a patient who did not have HIV or another disorder of cell mediated immunity. He was treated with intravenous imipenem, vancomycin, and rifampin for eight weeks and recovered from the infection.

Sturge Weber syndrome

A variant of hemangioma and an uncommon congenital condition, the Sturge Weber syndrome (SWS), also called encephalo trigeminal angiomatosis, is a neurocutaneous disorder with angiomas involving the skin of the face (cutaneous angioma) and pia arachnoid (leptomeningeal angioma). It occurs typically in the ophthalmic and maxillary distributions of the trigeminal nerve (1,2). Here we present a case of a 14 year old girl.

Ameloblastomatous calcifying odontogenic cyst: a rare histologic variant

Calcifying odontogenic cyst (COC) is an uncommon developmental odontogenic cyst first described by Gorlin in 1962. It is considered as extremely rare and accounts for only 1% of jaw cysts reported. Because of its diverse histopathology, there has always been confusion about its nature as a cyst, neoplasm or hamartoma. Several subclassifications have been proposed. Here, we present a case of calcifying odontogenic cyst with ameloblastic proliferation - an extremely rare histologic variant. The classical histologic features of the lining epithelium in the form of cords and presence of characteristic ghost cells were seen along with ameloblastomatous proliferations. Ameloblastomatous COC microscopically resembles unicystic ameloblastoma except for the ghost cells and calcifications within the proliferative epithelium. The nature of the COC is controversial. The case is presented here for its rarity, and difference between ameloblastomatous COC and ameloblastoma ex COC has been emphasized.

Relationships of maternal blood lead and disorders of pregnancy to neonatal birthweight

Transient complications of pregnancy (anemia, toxemia, proteinuria, arterial hypertension and hyperemesis) were studied in pregnant women from the general population reporting to local hospitals. Comparison of blood lead levels (PbB) was made between women with normal pregnancies and those with complications. Significantly higher PbB were found in women with pregnancy complications as compared to those with normal pregnancies. Increments in the PbB levels were accompanied by statistically significant decrements in neonate birthweights. Complications of pregnancy may be induced by higher PbB and may also compound the adverse effects of decrements of neonate birthweights

Incidence of neural tube defects of Lucknow over a 10 year period from 1982-1991

Open neural tube defects (NTD) in babies, occurring over a 10 yr period (1982-91), in four major maternity hospitals of Lucknow, were identified to analyse the incidence of this disorder. The overall incidence of NTD was found to be 3.9/1000. It was significantly higher in the teaching hospital compared to non-teaching hospitals. But there was no significant difference in the incidence of NTD between the Government and Private hospitals. During the decade (1982-91) under study there was no decline in NTD births. These data could serve as base-line for the incidence of NTD in north India, as NTD is expected to decline with the introduction of folic acid for the prevention of NTD.

Relationship of progesterone in plasma and whole milk of buffaloes during cyclicity and early pregnancy

Blood and milk samples were collected on alternate days from 5 cycling buffaloes on 16 occasions and 2 pregnant buffaloes on 13 and 8 occasions. The blood and milk samples were analysed for progesterone by sensitive direct radioimmunoassay (RIA) procedures developed in this laboratory. The calculated correlation values (r) between plasma and milk progesterone concentrations during cyclicity were 0.8143, 0.5454 and 0.8147 on 0 to 4, 6 to 14 and -6 to -2 days, prior to next oestrus (day 0 = day of oestrus) and the correlations for individual buffaloes during cyclicity were in the range of 0.82 to 0.89 for plasma and milk progesterone concentration. The correlation between milk and plasma levels during early pregnancy in buffaloes was very low (0.1472). The linear regression equation between milk (Y, ng/ml) and plasma (X, ng/ml) progesterone concentration was Y = 1.8 + 3.61X which indicated that the milk progesterone levels were about 4 times higher than those in plasma. It was concluded from this study that in certain situations, such as during cyclicity when large variations occur in corpus luteum activity, the milk and plasma progesterone concentrations from the same buffalo are highly correlated. However, the correlation is very poor when corpus luteum activity remains more or less unchanged, as seen during pregnancy.