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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 9 | Issue 1
Page Nos. 1-66

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REVIEW ARTICLE  

Gene therapy in oral cancer – An update p. 1
LJ Sai Lakshmi, T Radhika, Nadeem Jeddy
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_114_19  
Gene therapy is the use of DNA as an agent to treat genetic disorders. Gene therapy aims at the insertion of a therapeutic gene into the cells of a patient for the correction of an inborn error of metabolism, to alter or repair an acquired genetic abnormality. Today, most of the gene therapy studies are aimed at cancer and hereditary diseases which are linked to genetic defects. Cancer usually occurs due to the production of multiple mutations in a single cell which cause it to proliferate out of control. Several methods such as surgery, radiation therapy, and chemotherapy have been used widely to treat cancers, but recurrence is common in approximately one third of patients. To improve the treatment modality and to increase the survival rate, gene therapy can be used as an adjunct to other therapies for cancer patients. The purpose of this article is to review the concepts and technique, with an insight into the current research on its applications in oral squamous cell carcinoma (OSCC).
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ORIGINAL ARTICLES Top

Comparative evaluation of microleakage of conventional crowns and endocrowns using confocal laser scanning electron microscope – An in vitro study p. 6
Kakollu Sudha, Thota Murali Mohan, Kalagotla Aparna, Bhupathi Sravanthi Yadav, Ediga Sandhya Rani, Dunnala Lakshmi Sowjanya
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_1_20  
Background and Aims: The purpose of this study was to compare the microleakage of conventional crowns and endocrowns using confocal laser scanning electron microscope. Materials and Methods: Thirty extracted human permanent mandibular molars were collected and sectioned parallel to the occlusal surface at 2 mm above the CEJ to deroof the pulp chamber. Endodontic treatment was performed. The gutta-percha was removed 1 mm below the orifice of each canal, and flowable resin composite was filled in the canals up to the level of the pulp chamber. Samples were then randomly divided into two groups with 15 teeth each according to the type of post endodontic restoration given – Group 1: conventional crowns and Group 2: endocrowns. In Group (1), teeth were restored with composite cores, wide circumferential deep chamfer margin (0.8 mm) was prepared at the CEJ and 2 mm from the occlusal surface, 1.5 mm were cut from the axial walls. In Group (2), preparation was performed by making a circular butt margin with a central retention cavity with rounded internal line angles. Impressions were made, crowns were fabricated, and cementation was done, followed by thermocycling. The specimens were coated with varnish up to 1 mm from the crown margins, placed in Rhodamine B dye for 60 h, rinsed thoroughly for 30 s, sectioned with hard tissue microtome and examined for microleakage. Statistical Analysis: Statistical analysis was accomplished with the Student t-test, and significance was predetermined at P < 0.05. Results: In this study, endocrowns (6.158) showed significantly low microleakage compared with conventional crowns (14.052). Conclusion: Endocrowns showed significantly lower microleakage.
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Outcomes of complete mitral valve excision and replacement with tilting disc (TTK Chitra) valve for rheumatic mitral valve stenosis p. 12
K Venkatavijay, Y Vivekananda, K Hemasundar, NN L Rajitha
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_75_19  
Background: Mitral valve (MV) disease is one of the earliest diseases of the heart, and rheumatic MV disease is one of the first discovered in the world dating back to the 19th century. Rheumatic heart disease (RHD) is declining in other countries, but it is still prevalent in the rural parts of India especially in lower economic group. In our hospital, we have operated 50 cases of rheumatic mitral stenosis for whom mitral valve replacement (MVR) with tilting disc (TTK Chitra valve) was done. Most of the MV cases have MV score >12 and the subvalvular apparatus was severely affected. In all the cases we have operated, we have excised complete valve and no posterior leaflet preservation or chordal tethering and repair was done. Objectives of the study: To study MVR outcomes with tilting disc TTK Chitra valve and to compare pre- and postoperative valve gradient across tilting disc prosthetic valves and also study the left ventricular (LV) dimensions pre and post MVR and to study ejection fraction (EF) pre and post valve replacement and complications arising from posterior leaflet excision. Materials and Methods: Fifty patients with chronic RHD Chronic Rheumatic heart Disease (CRHD) with severe mitral stenosis were taken up for the study who were operated in this department from May 2016 to April 2019. All the patients were evaluated with 2D echo, electrocardiogram, and coronary angiogram (when they were >35 years old). Results: Out of 50 patients operated in our hospital, 34 were females, that is, 68% of the patients, and 16 patients were males, that is, 32%. As per age, 20 patients were between 41 and 50 years of age, that is, 40% belonged to 41–50 years of age; 39 patients were below 50 years, that is, 78% of patients were below 50 years; 4% are below 20 years; and 22% were above 50 years. As per the combined age and sex ratio also among both males and females, most Mitral Stenosis (MS) presumed below 50 years only. As per the valve area, the most common valve by preoperative echo was 66% below and equal to 1 cm[2] by Pressure half time (PHT) and Planimetry. About 60% of the patients had preoperative EF of more than 55% and less than 10% had between 36% and 40%. Preoperatively, 40% of the patients had severe pulmonary arterial hypertension (PAH), 30% of the patients had moderate PAH, and 30% of the patients had mild PAH. All these patients had been operated for MV where posterior leaflet was excised and no subvalvular apparatus was conserved and no chordal repair was done, but apparently no postoperative LV dysfunction was found in these patients. All these patients had taken up for MVR and TTK Chitra valve between 27 and 31 was used. In 70% of the patients, 29 and 31 TTK Chitra valve was used. This study is based on the echocardiographic analysis of the preoperative mean gradient across MV and postoperative mean gradient across MV which shows a considerable, comparable, and acceptable mean gradient postoperatively. Conclusion: Whenever rheumatic mitral stenosis is present, complete valve can be reasonably excised without even sparing or preserving the subvalvular apparatus and it does not affect the EF and LV function. Native tilting disc valve, that is, TTK Chitra valve, can be safely used and it can give comparable results with the recent generation valves. Better outcomes are encountered with 29-mm size and above valves. Pulmonary artery hypertension decreases significantly if mitral stenosis is operated regardless of the advancement of disease process. There is no significant change in the LV parameters, and pre- and postoperatively EF remained the same.
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Assessment of healthy lifestyle and wellbeing status among the employees of a tertiary care hospital p. 20
Vanajakshamma Velam, Latheef Kasala, Rajasekhar Durgaprasad, Aparna R Bitla
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_103_19  
Background and Aims: Individual barriers to change in lifestyle include lack of proper knowledge particularly about nutrition and physical activity, lack of acceptance to change behaviour, lack of self-motivation and lastly physical and socioeconomic limitations. Methods: This is a prospective, questionnaire based study conducted at a tertiary care hospital between May and August of 2019. A total of 777 employees working at different professional levels were enrolled in to the study. All the enrolled employees were subjected to a detailed questionnaire consisting of various dimensions of health which includes physical health, mental health, social health, spiritual health and intellectual health dimension. Results: The mean age of the study group was 37.38 ± 9.74 years (range: 17-68 years). Among the participants, 42.1% are male and 57.9% are female. Most of the study participants are practicing moderate physical activity (67.6%). Current smokers and alcoholics are 2.1% and 9.3% respectively. Diabetes and hypertension was seen in 7.3% and 9.7% respectively. The overall wellbeing showed that 40.8% of the staff are having good wellbeing and 31.5% showed some wellbeing risks. Outstanding wellbeing score was observed in 22.9% and only in 4.8% showed serious health risks related to their wellbeing. Conclusion: The overall wellbeing in healthcare staff is good at our tertiary care hospital. Majority of the staff showing risks with regards to their physical wellbeing due to poor exercise practices and abnormal food intake behaviour. Joint family system was found to be a factor for better mental health wellbeing among healthcare staff. Practicing exercise, meditation, yoga and controlling abnormal food intake leads to further wellbeing improvement.
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The cytomorphological spectrum of Hashimoto thyroiditis and its correlation with serological parameters: A study in the coastal region p. 25
Nibedita Sahoo, Sujata Naik, Pranita Mohanty, Pradeep N Sahoo, Prateek Das
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_125_19  
Objective: To analyse the detailed cytomorphological spectrum in Hashimoto thyroiditis (HT), cytological grading and its significance with the hormonal and antibody status Methods: This is both a prospective and retrospective study of 102 cases of HT in a tertiary care institute of the eastern part of India. Detailed cytological parameters were observed, graded and correlated with the serological parameters. Results: The majority of patients were females with a younger age group (21–30 years) and diffuse thyromegaly was the common presentation. A good number of cases showed neutrophilic infiltration, background colloid and follicular hyperplasia. Among the cytological parameters, Hurthle cell change was correlated with hypothyroidism (P < 0.05) but there was no significant correlation with the anti-TPO antibody. Statistical correlation of different cytological grades with the anti-TPO antibody was significant (P < 0.05), however the thyroid hormone profile with cytological grade and TPO level were not significant (P > 0.05). Conclusion: A younger age of presentation in a coastal area with iodine sufficiency and supplementation needs further epidemiological studies. Fine-needle aspiration cytology is superior to other sophisticated methods in diagnosing HT, even in seronegative cases. A good number of cases displaying folliculolysis by neutrophils needs to be corroborated by larger studies. One should be vigilant while examining slides to rule out associated malignancy.
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Awareness on Bioterrorism among qualified dentists in a teaching dental institution in southern India p. 32
Vemuri Sridevi, Bommireddy Vikram Simha, Sai Siva Naga Gayathri Naidu, Kommineni Harish Chowdary, Anusha Yaragani, y Sandhya Sree
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_112_19  
Background: Bioterrorism covers a vast spectrum of concerns, from catastrophic terrorism with mass casualties, to micro-events using low technology but producing civil unrest, disruption, disease, disabilities, and death. In such a situation, the medical community should educate the public about the threat. Education of the dental profession regarding the medical and oral manifestations of diseases that may result from a bioterrorist attack will be important. Thus, our aim of the study was to assess the knowledge, practice, and attitude toward bioterrorism among postgraduate dental students and dental staff in a private institution. Methods: Using convenience sampling, postgraduate dental students and the teaching staff of an institute in Guntur were given a questionnaire to assess them regarding bioterrorism. The questionnaires were collected, and the Chi-square test was performed with IBM. SPSS Statistics version 20 windows program software. Results: About 61.9% of postgraduate dental students and dental staff were aware of the term bioterrorism. More than 68.18% of postgraduate dental students and 67.7% of dental staff were not aware of the pathogenic agents of bioterrorism, and they have not attended either any lecture on it. Conclusion: Dental staff had better knowledge about bioterrorism compared to postgraduate dental students. Hence, there is a need to include training and education in the predoctoral dental and dental hygiene curriculums and developing CE courses for practicing dental professionals.
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Prevalence of Rotavirus diarrhea among under-five hospitalized children in government tertiary hospital, Tirupati p. 37
Manohar Badur, Ravi Kumar Panabaka, Madhavi Latha Naramalli, Shankar Reddy Dudala, Shabbir Ali Shaik, Gagandeep Kang, Naveen Kumar Cheri
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_275_14  
Context: Rotavirus is the most common cause of severe diarrhea requiring hospitalization among infants and young children worldwide. The prevalence of Rotavirus diarrhea in India has been found to vary from 5% to 71% in hospitalized children less than 5 years of age with acute gastroenteritis. The seasonal variation of Rotavirus diarrhea in India varies in different geographical regions with high incidence in winter months, at low relative humidity in north India. Aim: To estimate the prevalence of Rotavirus diarrhea among the hospitalized children of age less than 5 years. To know the genotypic distribution of Rotavirus causing diarrhea. Settings and Design: Study design: Hospital-based cross-sectional study. Study setting: Pediatrics Department of Sri Venkateswara Ram Naraian Ruya Government General Hospital, Tirupati. Study period: 20th September 2012 to 19th September 2013. Methods and Materials: Study units: Children less than 5 years of age presenting with diarrhea. Stool specimens from all hospitalized children of age less than 5 years who had presented with acute watery diarrhea were collected and tested for Rotavirus by enzyme-linked immunosorbent assay (ELISA). Positive samples were tested for G and P typing by reverse transcription polymerase chain reaction technique. Statistical Analysis Used: Percentage and Chi-square analysis. Results: Among the study sample, 68.7% of children were in the age group between 1 and 12 months and 25.6% of children showed positive result for Rotavirus by ELISA. Of the Rotavirus positives, 50% were G1P8 viruses. Conclusion: Rotavirus is an important cause of diarrhea in hospitalized children.
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A quantitative expression of KI-67 to assess the malignant transformation potential in oral leukoplakia and erosive lichen planus p. 42
Haranath Danda, Poosarla C Pusarla, Gontu S Reddy, Kattappagari K Kumar, Lalith P Chandra, Baddam V R Reddy
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_77_19  
Introduction: The basic, living, structural and functional unit of the body is known as a 'Cell'.[1] In both embryonic and post-embryonic existence, cell proliferation plays an important role in the biological process of living organisms.[2] The loss of control in the biological process leads to cancer. Leukoplakia and erosive lichen planus (ELP) are potentially malignant disorders. Ki67 is a protein indicative of cell cycle progression and cell proliferation. Aim: To evaluate the quantitative expression of Ki-67 in oral leukoplakia (OL) and ELP. Materials and Methods: Samples were divided into three groups, namely, paraffin-embedded (PE) tissue blocks (10 each) of normal oral mucosa tissue obtained from individuals undergoing third molar surgical removals (Group I); OL (Group II) and ELP (Group III), all of which were confirmed histologically. All the sections were subjected to immunohistochemistry (IHC) using Ki-67, and the number of immunopositive cells was evaluated. Results: Ki-67 positivity in three groups was observed as 31% in controls, 40% in leukoplakia and 36% in ELP. Conclusion: Our study revealed more Ki-67 positivity in leukoplakia than ELP, which indicates more malignant transformation potential for Leukoplakia.
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Quantitative analysis of microvessels density in different grades of oral squamous cell carcinoma p. 46
Dasarathi Alivelu, Kiran Kumar Kattappagari, Jyothsna Mandapati, Chandrashekar Poosarla, Sridhar Reddy Gontu, Venkata Ramana Reddy Baddam
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_56_19  
Background: Oral cancer is the sixth most common cancer in the world today. Angiogenesis plays a vital role in neoplasm growth and metastasis. It is modulated by both angiogenic stimulators and angiogenic inhibitors. Cluster of differentiation 31 (CD31) is expressed on endothelial cells and has been implicated in the adhesion and migration of endothelial cells during angiogenesis. Aims and Objectives: The aim and objectives of this study are to analyze the expression of CD31 in different histological grades of oral squamous cell carcinoma (OSCC), to determine the microvessel area (MVA) using a CD31 marker. Materials and Methods: The retrospective study was undertaken on 10 cases each of different grades of squamous cell carcinoma. Immunostaining using CD31 was used to demonstrate blood vessels. MVA was calculated using measurement tools in image analysis software and compared between the groups. One-way analysis of variance was used for comparing the parameter for multiple groups. Pairwise comparison of different grades of squamous cell carcinoma with the mean vascular area by Tukey's multiple analysis was done. Results: The mean vascular area decreased from well-differentiated squamous cell carcinoma to moderately differentiated carcinoma and was statistically significant (P ≤ 0.05) and increased from moderately differentiated squamous cell carcinoma to poorly differentiated squamous cell carcinoma and showed no statistical significance (P ≥ 0.05). Conclusion: Our study suggests that CD31 can be used as a prognostic indicator in OSCC.
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Differences in antimicrobial activity of 0.2% Chlorhexidine mouthwash and a Herbal mouth rinse formulation—A salivary bacterial counts study p. 52
Subramaniam M Rao, C Naresh Kumar, Puneet N Jumani, Abhilasha S Patil, Rachakonda Suresh Kumar, Rekha Marullappa
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_66_19  
Background: Chlorhexidine gluconate (CHX) mouthwash has earned eponym of gold standard to treat or prevent periodontal disease. However, it has been reported to have local side-effects on long-term use. To explore a herbal alternative, the present study was carried out to evaluate the clinical antimicrobial activity of two mouth rinses. One containing 0.2% CHX and other containing herbal mouth rinse (HM). Methods: This randomized, crossover salivary bacterial counts, was carried out on a sample of 10 healthy volunteers rinsed for 1 minute with 0.2% CHX and for 1 minute with HM. Saliva samples were obtained before rinsing, and after 5 min, and 1, 3, 5 and 7 h. These samples were cultured both aerobically and anaerobically. Percentages of survival, in regard to baseline, were calculated for each time point. Results: Results were available both for aerobic and anaerobic salivary bacteria. Statistically significant difference is observed between Herbal and 0.2% CHX mouth wash at 1 hr (P < 0.05), 3 hrs (P < 0.01), 5 hrs (P < 0.01) as well as at 7 hrs (P < 0.001) and HM and 0.2% CHX mouth wash at 5 minutes after using mouth wash (P < 0.05), 1 hr (P < 0.05), 3 hrs (P < 0.01), 5 hrs (P < 0.01) as well as at 7 hrs (P < 0.001). Conclusion: Based on the results, this clinical study demonstrated that significant reduction of microbial activity was observed in 0.2% CHX when compared with HM containing bibhitaka, nagavali and salvodora persica as main ingredients.
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CASE REPORTS Top

Tenofovir-induced quadriparesis p. 57
Ashalatha Muppur, J Mohan Sidhartha, Sd Allahuddin
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_82_18  
With an ever-increasing trend in the side effects of antiretroviral therapy (ART), usage of new regimens to decrease the mortality and morbidity has come into picture. Here we report a case of tenofovir-induced hypokalemic paralysis. A 60-year-old female patient came to a medical outpatient department with quadriparesis. History revealed that she was diagnosed with HIV 6 years back and was on zidovudine, lamivudine, and efavirenz. Three months later, she developed severe anemia because of which zidovudine was replaced by tenofovir. On evaluation, there was hypokalemia with appropriate electrocardiography changes. As previous literature showed association of hypokalemia with tenofovir, we attributed this finding to the usage of tenofovir. ART was stopped, and the patient was given potassium supplements and potassium-rich diet. There was dramatic improvement with the treatment and the patient regained muscle strength. After 1 week, she was put on other alternative regimen consisting of abacavir, lamivudine, and efavirenz. Her CD4 count was improved without any complaints. The patient was monitored on outpatient basis in ART center.
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Lower limb vascular access for maintenance hemodialysis patients – A case series p. 60
T Nagalakshmi, C Mahesh, K Siva Parvathi, R Nagaraj, A Sunnesh, N Sai Sameera, K Naveen Kumar, Siva Kumar Vishnubotla
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_47_19  
The vascular access is considered as Achilles heel of a successful maintenance hemodialysis (MHD) program. Although it is ideal to initiate the dialysis through arteriovenous fistula (AVF), many of the patients start initiation through central venous catheters which predispose them later to multiple access complications. Also, as the elderly population has poor vasculature to support AVF, many of them end up exhausting all upper limb vascular accesses. As a result, there are a group of MHD patients with difficulty in using upper limb vascular access secondary to multiple access failure who are otherwise unable to switch to another modality of renal replacement therapy completely and have to rely on lower limb vascular access as a last resort to sustain life. We would like to share our experience on lower limb vascular access in our institute. The three types of lower limb vascular accesses include lower limb AVF, lower limb AV graft, and tunneled femoral vein catheter as illustrated in three patients with a successful utilization in sustaining life.
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Case report: Primary intraosseous neurofibroma of maxilla p. 63
Y Raghavendra Reddy, M Rajinikanth, B Radhika, C N V Akhila
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_65_18  
The present article is a case report of solitary neurofibroma of oral cavity in a 50-year-old male patient. Patient reported with chief complaint of swelling in relation to upper front teeth region since 2 months. Based on clinical, radiographical, and histopathological findings the diagnosis of neurofibroma was made. Neurofibroma involving oral cavity as primary lesion is very rare in occurrence. It mainly involves tongue, palate, and buccal mucosa. Surgical excision is performed in the present case.
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