Demonstration of Urease Activity in Subgingival Plaque Sample of Periodontitis Patients in a Tertiary Care Center of Nepal

Introduction: The urease activity is produced by many oral and gastric microorganisms, which have demonstrated systemic implications as well. Urea can be detected both from saliva and gingival crevicular fluid, which could suggest that the oral cavity can act as an extragastric reservoir for many microbes leading to serious systemic diseases. Objective: The main objective of this current study was to find out the urease activity in human dental plaque. Methods: An analytical cross-sectional study was conducted from September to November 2023 in patients visiting the Department of Periodontology and Oral Implantology. The urease activity was detected using a rapid urease test (RUT) kit from a hundred cases diagnosed with periodontitis. All systemically healthy patients excluding patients on ongoing proton-pump inhibitor therapy were selected for the presence/absence of periodontitis as per the 2017 World Workshop classification. Data were collected and entered into Microsoft Excel, and further analysis was done using SPSS v.20. Results: Out of 100 patients, urease activity was found positive in 85 (85%) patients. Regarding gender and age, the urease activity was not much different and was not statistically significant (P value= 0.163 and 0.382 respectively). Conclusions: The results of this study suggest there is a high urease activity in dental plaque samples whose removal is essential to prevent our body from systemic threats like bacterial endocarditis, gastric carcinoma, etc. caused by urease-producing microorganisms.

Root Dentin Transparency: A Reliable Method of Age Estimation in Nepalese Population

Background: Root dentin transparency, one of the age changes in dentin, is considered to be a stable parameter not affected by environmental and pathological factors. The effect of age changes in the transparency of root dentin in Nepalese population have not been established so far. In the present study, we aimed to determine the age of an individual using the root dentin transparency in the Nepalese subjects and attempt to derive the formula to estimate the age applicable to the Nepalese population. Materials and Methods: A cross sectional analytical study was conducted to measure the length of root dentin transparency in the tooth of patients of known age. Correlation of the age and the length of transparent root dentin was determined. A linear regression analysis was carried out to derive a formula applicable to the Nepalese population. Results: The length of transparent root dentin increased linearly with the age of an individual. The newly derived formula was used to calculate the estimated age from the length of transparent root dentin. The difference between the actual age and the calculated age was within 6 years in 63.2% of the sample. Conclusion: A simple and relatively inexpensive method for calculating age by measuring RDT is described.

Dental Caries on Deciduous Molars among Children Visiting Dental Outpatient Department of a Tertiary Care Centre

Introduction

Dental caries is one of the most common, yet preventable childhood diseases. The aetiology of dental caries lies in the interplay between host, microorganism, substrate, and time. Risk factors for dental caries include physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty. The aim of the study was to find out the prevalence of dental caries on deciduous molars among children visiting dental Outpatient Department of a tertiary care centre.

Methods

This descriptive cross-sectional study was conducted on children who visited the dental outpatient department of Kathmandu University School of Medical Sciences, Dhulikhel Hospital from 15 June 2023 to 30 July 2023. Ethical approval was taken from the Institutional Review Committee of the same institute. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

The prevalence of dental caries on deciduous molars in children was 252 (93.33%)(90.35-96.30, 95% Confidence Interval). One-third of the children had visited dental clinics for the first time. Lack of topical fluoride application was seen in the majority of the children.

Conclusions

The prevalence of dental caries on deciduous molars among pediatric patients was found to be higher than in other studies done in similar settings.

Keywords

children; dental caries; molars; prevalence.

Fissured Tongue among Patients Visiting the Department of Oral Medicine and Radiology in a Tertiary Care Centre

Introduction

Examination of the tongue and knowledge of its variation can aid clinicians in correctly assessing the cause of a patient's complaint. Despite World Health Organization recommendations to encourage more epidemiological assessment of oral mucosal variations and lesions, the volume of literature in this area is limited. This study aimed to find out the prevalence of fissured tongues among patients visiting the Department of Oral Medicine and Radiology in a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among patients visiting the Department of Oral Medicine and Radiology in a tertiary care centre. Data was collected from 12 March 2023 to 10 May 2023 after obtaining ethical approval from the same institute. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Out of 540 patients, the prevalence of fissured tongue was 73 (13.51%) (10.63-16.40, 95% Confidence Interval). A total of 34 (46.57%) were males and 39 (53.42%) were females.

Conclusions

The prevalence of fissured tongue among patients visiting the Department of Oral Medicine and Radiology was higher than other studies done in similar settings.

Keywords

anatomic variation; fissured tongue; Nepal; oral mucosa; prevalence.

Clinico-demographic Profile of Undifferentiated Inflammatory Arthritis Patients

BACKGROUND

Undifferentiated inflammatory arthritis is a group of inflammatory joint diseases that do not fulfil the classification criteria for any other rheumatic or connective tissue disorders. This study aims to describe the clinical, demographic and serological features of undifferentiated inflammatory arthritis cases presenting at a tertiary level rheumatology centre from Nepal.

METHODS

A descriptive cross-sectional study conducted at National Centre for Rheumatic Diseases, Kathmandu, Nepal which represents a midterm analysis of the undifferentiated inflammatory arthritis registry maintained at the centre. Patients more than 18 years of age, who consented for the study having least one swollen or tender joint were enrolled. Ethical approval was obtained from Nepal Health Research Council.

RESULTS

A total of 1120 patients were enrolled in the study out of which 941 (84%) were females. The mean age at diagnosis was 46.0±12.8 years and most of them were in overweight range (mean BMI: 27.0±5.8) with 818 (73%) patients having BMI more than 24.0. Patients mostly had low disease activity at presentation (DAS 28 score of 2.5±0.8). Other markers of inflammation and patient reported outcome measures (health assessment questionnaire, patient global assessment and visual analogue scale) were also in the moderate range. Seropositivity for anti-citrullinated peptides and anti-nuclear antibodies was seen in 5 (0.45%) and 43 (3.8%) patients respectively. Majority of patients were non-smokers (77%). Inflammatory arthritis on musculoskeletal ultrasonography was seen in 638 (57%).

CONCLUSIONS

Undifferentiated inflammatory arthritis was more common in overweight females. Serological markers and smoking status are not common features in these patients.

DNA hypermethylation of sirtuin 1 (SIRT1) caused by betel quid chewing-a possible predictive biomarker for malignant transformation

BACKGROUND

DNA hypermethylation of tumor suppressor genes is observed in precancerous lesions and oral cancer of individuals with the habits of betel quid (BQ) chewing. SIRT1 has been identified as playing a role in the maintenance of epithelial integrity, and its alteration is often related to carcinogenesis. However, the methylation and transcription status of SIRT1 in patients with BQ chewing-related oral cancer has not been investigated. We examined the methylation status of SIRT1 in paraffin-embedded tissue samples of oral squamous cell carcinoma (OSCC) obtained from BQ chewing and non-chewing patients and in tissue samples from healthy control subjects. In addition, we examined whether the hypermethylation of SIRT1 followed by its transcriptional downregulation in the human gingival epithelial cells could be caused by arecoline, a major component of BQ. Furthermore, we investigated the methylation status of SIRT1 in smear samples of macroscopically healthy buccal mucosa from subjects with a habit of BQ chewing.

RESULTS

SIRT1 was significantly hypermethylated in tissue samples of OSCC from BQ chewers and non-chewers than in oral mucosa from healthy control subjects. Results also showed that the hypermethylation level of SIRT1 was significantly higher in OSCC of patients with BQ chewing habits than in those of non-chewing habits (p < 0.05). Our in vitro model showed that hypermethylation is followed by downregulation of the transcriptional level of SIRT1 (p < 0.05). The methylation levels of SIRT1 in the smear samples obtained from BQ chewing individuals were significantly higher than those in the samples obtained from individuals that did not chew BQ. The duration of BQ chewing habits was correlated positively to the frequency of SIRT1 hypermethylation (p < 0.05).

CONCLUSIONS

Our results suggest that DNA hypermethylation of SIRT1 is involved in the occurrence of oral cancer in BQ chewing patients and that hypermethylation in the oral mucosa of BQ chewers could be a predictive marker for the occurrence of malignant transformation. This is the first report that showed DNA hypermethylation in clinically healthy oral epithelium of BQ chewers. Our study shows evidence that DNA hypermethylation may be an early event of oral carcinogenesis prior to observable clinical changes.

Immunohistochemical Localization of RNase 7 in Normal and Inflamed Oral Epithelia and Salivary Glands

RNase 7 is a skin-derived antimicrobial peptide expressed in various epithelial tissues. It is upregulated by stimulation with microbes and pro-inflammatory cytokines. Herein, we examined the expression levels of RNase 7 in tissues from normal and inflamed oral epithelia and salivary glands via immunohistochemistry. RNase 7 was expressed mainly in the surface layers of the parakeratinized and orthokeratinized oral epithelium. In addition, it was strongly and weakly expressed in oral lichen planus and radicular cysts, respectively. RNase 7 was constitutively expressed in salivary glands, particularly in the serous and duct cells. In the case of Sjogren’s syndrome, RNase 7 was strongly expressed in serous, ductal, and mucous cells in areas with lymphocytic infiltration. The localization patterns of RNase 7 were similar to those of other epithelial antimicrobial peptides, including beta-defensins. Thus, epithelial antimicrobial peptides may act against microbial infections in a coordinated manner in oral epithelia and salivary glands.

Adenomatous ductal proliferation/hyperplasia in the parotid gland associated without any other pathological lesions; a report and survey of the literatures

Adenomatous ductal proliferation/hyperplasia (ADP/H) is a rare hyperplastic condition of the salivary gland. It is mostly associated with other salivary gland pathologies such as tumors and inflammations, and is incidentally found in tissue sections during histopathological examinations of those diseases. Herein, we report a case of ADP/H in the parotid gland not associated with any other pathological lesions, and present a review of the literature on this condition. A 60-year-old Japanese female complained of swelling on the left side of parotid region. Clinical examination revealed a swelling on the lower lobe of the left parotid gland. The lesion was firm but non-tender and was not attached to adjacent structures. A clinical diagnosis of benign salivary gland tumor was reached, and surgical excision was performed under general anesthesia. Histopathological examination revealed an intact parotid gland capsule with isomorphic and basaloid cells within scanty cytoplasm. In addition, an admixture of hyperplasia and proliferation of the intercalated ducts, the presence of zymogen granules, the absence of solid nests, and a peripheral palisaded arrangement of the cells were observed. Based on these findings, a diagnosis of ADP/H was confirmed. ADP/H is a non-tumorous lesion; therefore, tumor involvement should be ruled out before the diagnosis is reached.

Upregulated expression of MMP-9 in gingival epithelial cells induced by prolonged stimulation with arecoline

Betel quid chewing is implicated in the high prevalence of oral cancer in Southeast Asian countries. One of the major components of betel quid is arecoline. In the present study, in order to characterize the association between chronic arecoline stimulation and carcinogenesis the expression level of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2 mRNA in human gingival epithelial progenitor cells (HGEPs) stimulated with arecoline was assessed. The HGEPs were alternated between 3 days of incubation with arecoline (50 µg/ml), and 3 days without arecoline, for up to 30 days. The expression levels of the MMPs and TIMPs in the cells stimulated with arecoline were evaluated by reverse transcription-quantitative polymerase chain reaction at 18 and 30 days. The expression of MMP-9 mRNA in the experimental group was significantly increased compared with in the control group (P<0.01). No significant differences in the expression of MMP-2, TIMP-1 or TIMP-2 mRNA were observed between the experimental and control groups. Using an MMP-9 activity assay, the levels of MMP-9 activity in the experimental group were demonstrated to be significantly higher than in the control group (P<0.05). To investigate associated cellular signaling pathways, PDTC [a nuclear factor (NF)-κB/inhibitor of NF-κB (IκB) inhibitor], PD98059 [a mitogen-activated protein kinase kinase (MAPKK)1 and MAPKK2 inhibitor], SB203580 (a p38 MAPK inhibitor) and 5,15-DPP [a signal transduction and activator of transcription (STAT) 3 inhibitor] were used. All inhibitors decreased the extent of MMP-9 upregulation induced by stimulation with arecoline. Based on the data, it is hypothesized that MMP-9 activity may be involved in the pathological alterations of oral epithelium induced by betel quid chewing, and that the NF-κB/IκB, MAPK, p38 MAPK and STAT3 signaling pathways may be involved in the production of MMP-9 induced by betel quid chewing.

Hopelessness and Suicidal Ideation among Patients with Depression and Neurotic Disorders Attending a Tertiary Care Centre at Eastern Nepal

BACKGROUND

Hopelessness is thought to result from a negative appraisal system and interacts with, and worsens, appraisals of defeat and trap which in turn interact with suicide schema and lead to suicidal behaviour. This study was intended to assess hopelessness and suicidal ideation among patients with depression and neurotic disorders at tertiary care centre of eastern Nepal.

METHODS

A cross sectional design included 70 respondents by purposive sampling technique. Beck Hopelessness Scale and Scale of Suicidal Ideation were used to measure hopelessness and suicidal ideation, respectively. Data were analyzed using SPSS statistical software. Pearson chi-square, binary logistic regression and Spearmans' rho, test were applied at 95% confidence interval.

RESULTS

Mean ± SD age was 32.8 ± 13.5 years. Most (62.8%) of the patients were female and with the diagnosis of depression. Majority (66%) of the patients had hopelessness. There was no significant difference in hopelessness among patients with depression and neurotic disorders. About 17% respondents had suicidal ideation, among them 82.4% were female. There was no significant difference of suicidal ideation among patients with depression and neurotic disorders (p=0.013). Significant positive correlation between hopelessness and suicidal ideation was found (p=0.001). Binary logistic regression revealed hopelessness was independently related to income and family history of mental illness. Similarly, suicidal ideation was independently related to depression and family history of mental illness.

CONCLUSIONS

Female respondents, people living under poverty and positive family history of mental illness had more hopelessness and suicidal ideation.

Osseous choristoma of the tongue: two case reports

Background

Osseous choristoma is a very rare, benign lesion in the maxillofacial region. It appears as a benign mass of normally matured bony tissue covered by the normal epithelium of the tongue. It is usually seen in front of the foramen cecum of the tongue. Surgical excision is the treatment of choice with an excellent prognosis and there have been very few cases of recurrence.

Case presentation

Here we present two cases of osseous choristoma on the dorsum of the tongue. Case 1 was a 15-year-old Japanese girl who presented with a painless but gradually growing swelling on the dorsum of her tongue approximately 1 year before her admission. Case 2 was a 21-year-old Japanese woman with a complaint of pain in the lower left, posterior side of her mouth. Histological findings showed that both lesions were composed of well-organized, mature, compact bone beneath the oral mucosal membrane. Subsequent to simple surgical excision, no recurrence of the lesions was observed after the follow-up period. Previous literatures have proposed both malformation and trauma hypotheses as the etiopathologies of osseous choristoma. However, the histopathological findings of the two cases in the present study do not support the trauma hypothesis.

Conclusions

Although osseous choristoma is clinically a benign condition, the underlying histopathological processes are important. The outcome of aberrant formation of calcified tissue in the vicinity of vital structures such as nerves and blood vessels may be of clinical significance.

Understanding socio economic contexts of female sex workers in eastern Nepal

The present focus is mostly laid on high risk behavior of commercial sex workers without any consideration of their location, educational status and other socio-cultural norms. Thus, we designed a study to understand socio demographic characteristics, lifestyle of female sex workers and search for driving factors for prostitution in eastern Nepal. A descriptive study was conducted in three districts of Eastern Nepal in 2012 over the period of six months. The data regarding their socio demographic characteristics, income, reason for joining sex trade and future choice regarding the profession were recorded from 210 female sex workers through face-to-face interviews. Majority (53.3%) of respondents belonged to the productive age group of 20-29 years, more than one thirds (43.3%) had not received any form of formal education and were unmarried. More than half (53.80%) were presently living alone and about one thirds of the women (31.90%) were minors when they joined this profession. Major portion of the sample (94.80%) worked more than three days a week with median income of 15 thousand per month and 41 percent had sex with more than or equal to ten clients per week. Poor economic condition was the most frequent (47.6%) factor leading to joining of sex trade however, more than two thirds, (72.80%) wanted to quit the profession. Given low level of education, relatively low income, and young age among this population, empowerment and alternative employment/education opportunities should be created to develop this part of Nepalese society.

Community Based Survey on Psychiatric Morbidity in Eastern Nepal

INTRODUCTION

Mental health problem is common and ubiquitous. Mental illness cuts across all sections of society, irrespective of socio-economic status. Recent international survey showed a varying prevalence rates ranged (4.7%- 12.0%). The Community study in Nepal yielded prevalence rate of mental illness at 14.0%.

METHODS

This is a descriptive, epidemiologic study with systematic randomization sampling.

RESULTS

Of 911 respondents majority was married (76.1%), of age group 20-59 yrs. Overall, 113 (12.4%) respondents had at least one psychiatric disorder and the commonest were: Depression, Anxiety disorders, Alcohol use disorders with 1.9% had seizure/epilepsy.

CONCLUSIONS

Community prevalence rate of some common psychiatric disorders is high which calls for special attention to address depressive and alcohol related disorder from all quarters of society particularly from government.

Agenesis of Third Molars in Orthodontic Patients attending Dhulikhel Hospital

Aims and objective: The aim of this descriptive study was to determine the prevalence of agenesis or congenitally missing third molars in orthodontic patients attending Dhulikhel Hospital. Materials & Methods: A retrospective study of a total of 294 patients, of both genders ranging from 12 to 34 years of age who were orthodontically treated between August, 2010 to May 2012, were reviewed from the files of the Department of Orthodontics, Dhulikhel Hospital, Kathmandu University Hospital. The records included panoramic radiographs and study models of all patients with intra oral photographs at the beginning of treatment. Results: It shows that agenesis of one to four third molars was present in male group in 63 cases out of 94, i.e, 67.02% and in the female group in 85 cases out of 200, i.e. in 42.5%. In the group of male and female together, we found the agenesis of one to four third molars in 148 cases, which is 50.34 %. Conclusions: Data concerning the incidence of third molars agenesis belong to the essential characteristics of the dentition's status of the given population. Dental developmental anomalies can indicate the degree of genetic load of individuals and relatives. By analyzing the global term "agenesis of one to four third molars" it is possible to receive data, which are quite significant for the orthodontic treatment plan.

Antibiotic Susceptibility Patterns of Vibrio cholerae isolates

INTRODUCTION: Cholera is one of the most common diarrhoeal diseases in Nepal. Etiological agent of cholera is Vibrio cholerae which removes essential body fluids, salts and vital nutrients, which are necessary for life causing dehydration and malnutrition. Emerging antimicrobial resistant is common. The aim of the present study was to determine the antibiotic susceptibility pattern of cholera patients in Nepal. METHODS: All the laboratory works were conducted in the bacteriology section of National Public Health Laboratory, Teku from March to September 2005. During this period a total of 340 stool samples from diarrhoeal patients were collected and processed according to the standard laboratory methods. Each patient suffering from diarrhoea was directly interviewed for his or her clinical history during sample collection. RESULTS: A total of 340 stool samples were processed and studied from both sex including all ages of patients. Among the processed sample 53 Vibrio cholerae cases were found. All isolated Vibrio cholerae O1 were El Tor, Inaba. All isolated (100%) Vibrio cholerae O1 were sensitive to Ampicillin, Ciprofloxacin, Erythromycin and Tetracycline whereas all were resistant to Nalidixic acid and Cotrimoxazole. Only 15.1% cases were sensitive to Furazolidone whereas 84.9% were resistant. CONCLUSION: All V. cholerae strains isolated in this study were found resistant to Multi Drug Resistant (resistant to at least two antibiotics of different group). Ampicillin, Ciprofloxacin, Erythromycin and Tetracycline were found still more potent antibiotics against Vibrio cholerae isolated during the study. Keywords: antibiotics, susceptibility, Vibrio cholera.

Antibiotic susceptibility patterns of Vibrio cholerae isolates

INTRODUCTION

Cholera is one of the most common diarrhoeal diseases in Nepal. Etiological agent of cholera is Vibrio cholerae which removes essential body fluids, salts and vital nutrients, which are necessary for life causing dehydration and malnutrition. Emerging antimicrobial resistant is common. The aim of the present study was to determine the antibiotic susceptibility pattern of cholera patients in Nepal.

METHODS

All the laboratory works were conducted in the bacteriology section of National Public Health Laboratory, Teku from March to September 2005. During this period a total of 340 stool samples from diarrhoeal patients were collected and processed according to the standard laboratory methods. Each patient suffering from diarrhoea was directly interviewed for his or her clinical history during sample collection.

RESULTS

A total of 340 stool samples were processed and studied from both sex including all ages of patients. Among the processed sample 53 Vibrio cholerae cases were found. All isolated Vibrio cholerae O1 were El Tor, Inaba. All isolated (100%) Vibrio cholerae O1 were sensitive to Ampicillin, Ciprofloxacin, Erythromycin and Tetracycline whereas all were resistant to Nalidixic acid and Cotrimoxazole. Only 15.1% cases were sensitive to Furazolidone whereas 84.9% were resistant.

CONCLUSION

All V. cholerae strains isolated in this study were found resistant to Multi Drug Resistant (resistant to at least two antibiotics of different group). Ampicillin, Ciprofloxacin, Erythromycin and Tetracycline were found still more potent antibiotics against Vibrio cholerae isolated during the study.

Mini-open reduction and intramedullary interlocking nailing of fracture shaft of tibia without an image intensifier

Intramedullary interlocking tibial nailing is usually performed using an image intensifier. But being expensive, it is not available in the most of the hospitals of resource-poor countries of the world. The purpose of this study is to analyze the results of interlocking nailing without the use of an image intensifier. This is the retrospective study of 55 diaphyseal tibial fractures treated with minimally open reduction and internal fixation with interlocked intramedullary nail fixation. The proximal locking of the nail with the screws was made using external jig and for the distal locking direct visualization of the hole was carried out. There were 15 females and 40 males. The average age in years was 32 with a range of 18 to 64 years. The surgical approach was medial parapatellar. The average follow up period was 4 months. This period ranged from 3 months to 14 months. The union time in an average was 4 months. The complication mainly was distal screw loosening leading to valgus deformity and shortening in 1 case. It is, therefore, concluded that interlocking intramedullary nailing can be performed with proximal and distal locking accurately without the use of an image intensifier.