Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : ZC48 - ZC51 Full Version

Association of Oral Squamous Cell Carcinoma and Human Papilloma Virus Status in Chronic Periodontitis Patients: A Cross-sectional Study


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/58178.17419
Shikha Sharma, Shobha Prakash

1. Assistant Professor, Department of Periodontology, SGT Dental College, Gurugram, Haryana, India. 2. Professor and Head, Department of Periodontology, College of Dental Sciences, Davangere, Karnataka, India.

Correspondence Address :
Shikha Sharma,
H-95 Chander Nagar, Gurugram, Haryana, India.
E-mail: shikha1390@gmail.com

Abstract

Introduction: Apart from the alcohol and tobacco which are considered as an important cause for carcinogenesis, periodontal infections have also been considered equally important cause for it. Infections are increasingly considered as potential trigger for carcinogenesis apart from alcohol and tobacco. The role of the Human Papilloma Virus (HPV) in causing Oral Squamous Cell Carcinoma (OSCC), highlights the significance of the oral infections in the development of the OSCC.

Aim: To detect the relationship between Chronic Periodontitis, HPV, and OSCC.

Materials and Methods: This was a cross-sectional study conducted on 15 chronic generalised periodontitis patients with OSCC affecting alveoli and gingiva. DNA was extracted from the biopsy of the tissue sample for the detection of HPV by Polymerase chain reaction (PCR). The parameters assessed were the Clinical Attachment Loss (CAL), Tumor Node Metastsis (TNM ) staging of OSCC, HPV status and the presence of the periodontal marker bacteria. Chi-square test and spearman correlation were used to find association and correlation between the parameters.

Results: A total of 15 cases of chronic generalised periodontitis patients with oral squamous cell carcinoma were included in the study (7 males and 8 female patients, with a mean age of 50.8 years). Of these, HPV was found in 4 patients only. On comparison between Chronic Generalised Periodontitis (CGP) and OSCC, a non-significant association and a negative correlation was found. Similar analysis was observed between CGP and HPV. When comparison was done between HPV and OSCC, non-significant association (p-value 0.774) and a negative correlation(r- value= -0. 169) was found.

Conclusion: This study did not yield a significant association and correlation between these three parameters. Further prospective studies should be conducted which may help in the prevention of periodontitis and subsequently decreasing the incidences of OSCC.

Keywords

Chronic inflammation, Infections, Oropharyngeal carcinomas, Periodontal pockets, Polymerase chain reaction

The most widely diagnosed oral malignancy is OSCC, accounting for about 90% of the number, results in a significant damage and cancer related death each year. The most commonly found risk factors for the development of the OSCC includes, tobacco chewing, alcohol, betel quid ingestion, malnutrition as well as viral infection (1). A relationship between the HPV and oropharyngeal carcinoma has been established (2). Through the activation of the mitogen activated pathway and cyclin D1, there occurs cell proliferations and Deoxyribonucleic Acid (DNA) replication, which leads to an increased incidences in the cell transformation and genetic mutations leading to the tumour development (3). These patients are typically caucasians, non-smokers non-drinkers, and a group of younger patients than those diagnosed as HPV negative carcinoma group (4).

Periodontitis, which is a chronic oral infection involving an inflammatory reactions of the gram negative anaerobic bacteria in the dental plaque. The main effect of the periodontitis includes an irreversible alveolar bone loss around the teeth clinically detected as the Alveolar Bone Loss (ABL) (4). In chronic inflammation, the affected epithelium is assumed to show an increased risk for malignant transformation as certain studies have shown that the involved bacterial toxins, cytokines and inflammatory mediators of chronic inflammation have a potential for malignant transformation in-vitro (5),(6),(7) Bacterial and viral infections may also induce a chronic inflammation with the potential for malignant transformation (1).

A number of the benign conditions like condylomata acuminate, focal epithelial dysplasia, respiratory papillomatosis, gingival warts, and cervical cancers have been found to associated with the papilloma virus. These viruses have also found to be associated with head and neck cancers specifically oropharynx and the base of the tongue (8).

The basal cells of the epithelium are usually and exclusively infected by the human papillomavirus. The abrasion or the exposure of the parabasal cells like in transformation zone of the uterine cervix provides the access to the HPV. Periodontal pockets serve as the nice for the latent HPV. Infected cells serve as source for the latent virus to proliferate and differentiate. Thereby the HPV may be considered as an additional independent risk factor for a subset of Head and Neck Cancers (HNCs). However, most HPV infections are not responsible for causing malignancy as they are cleared rapidly (2). The most important risk factor for the carcinogenesis is the persistence of the HPV in the periodontal pockets in the latent state (2),(9).

Thus, the present study was taken-up to detect the relationship between OSCC, HPV and periodontitis.

Material and Methods

This cross-sectional study was designed to detect the occurrence of OSCC and HPV status in chronic generalised periodontitis patients. Patients were selected from the Department of oral and maxillofacial surgery, College Of Dental Sciences, Davangere, Karnataka, India. The study was stretched from September 2015-October 2017 after ethical approval was taken from the university board with the reference number CODS/977. Informed consents were obtained from all the participating subjects.

Inclusion criteria: Patients with age greater than 21 years, diagnosed with squamous cell carcinoma affecting alveoli and gingiva. (Table/Fig 1),(Table/Fig 2) along with radiographic appearance of chronic periodontitis i.e. bone loss (Table/Fig 2) and no history of periodontal therapy done in last 3 months were included in the study.

Exclusion criteria: Patients with immunodeficiency congenital anomalies, trauma, and any accident that involves the periodontium, edentulous patients, patients with a history of organ transplant, amyloidosis, HIV infection, autoimmune disorders, those with any other systemic conditions like diabetes, hypertension etc., pregnant and lactating mothers and those patients with a history of antibiotics and steroids medication within last 1 month were excluded in the study.

Procedure

The parameters selected for the study were age, sex, marital status, smoking, alcohol, mobility (Millers classification 1950) (10), missing teeth, TNM staging (Tumor, Node, Metastasis) Stage 0-IV (11), tumor site, Community Periodontal index(CPI) (12). The presence of OSCC was confirmed and explained using the TNM staging, the presence/ absence of HPV was confirmed by the PCR of the biopsy tissue and the chronic periodontitis was confirmed by the CPI index which elaborated the Clinical Attachment Loss(CAL) in the patients. Sub gingival plaque sample was collected from the affected site with the help of the curette for the detection of the Porphyromonas gingivalis and Tanerella forsythia to confirm the diagnosis of chronic periodontitis. Radiological parameters included Orthopantogram (OPG). Biopsy tissue sample was taken for the detection of HPV by PCR (13).

Statistical Analysis

Descriptive data that included Mean, Standard Deviations were determined for each clinical parameter in each group and were used for analysis. Chi-square test and spearman correlation were used to find association and correlation between the chronic generalised periodontitis, oral squamous cell carcinoma and human papilloma virus status. The p-value of 0.05 or less was considered for statistical significance.

Results

A total of 15 cases of chronic generalised periodontitis with squamous cell carcinoma were included in the study (Table/Fig 3). Shows 7 were male and 8 female patients, with a mean age of 50.8 ±10.65 years. Out of this, 6 patients were smokers and 3 consumed alcohol. The value of Community Periodontal Index (CPI) ranged between 3-4, loss of attachment score ranged from 1-3. On microbiological examinations, Tanerella forsythia was found in 2 patients and 4 patients were positive for Porphyromonas gingivalis. In 11 patients, localization of the tumor was found in relation to mandibular posterior and in 4 patients in maxillary posterior. In 4 patients out of total 15 patients, HPV was positive (Table/Fig 4).

On examination of the mobility of the teeth of the patients, 9 patients had grade I mobility, 3 had Grade II mobility and in 1 patient, the mobility was Grade III. Two patients presented with no mobility of the teeth. 13 patients were found to be partially edentulous, on the other hand, 2 patients were found to be completely dentulous.

On comparison between chronic generalised periodontitis and oral squamous cell carcinoma, a non-significant association and a negative correlation was found (Table/Fig 5). and HPV status (Table/Fig 6) and also on comparing OSCC and HPV status(Table/Fig 7) non-significant association and a negative correlation was found.

Discussion

In the present study, 15 chronic generalised periodontitis patients affected with squamous cell carcinoma of alveoli and gingiva were selected based on the history, clinical findings and the radiographic findings. The plaque sample for the detection of microbes was collected with the curette from the affected site (subgingival plaque) rather than the paper points. As with the curette, the amount of sample collected was more than the paper points as the curette collects the plaque sample from the entire pocket whereas the paper point collects plaque sample from the most coronal and outer portion of the pocket (14).

Microbiological culture was used to assess the presence of red complex bacteria especially Porphyromonas gingivalis and Tannerella forsythia. As these bacterias are associated with the bleeding on probing, an important clinical measurement of destructive periodontal diseases and also pocket depth (15). Treponema denticola was not included in the study as this microbe cannot be cultured.

From the chronic periodontitis, patients histopathologically confirmed with OSCC gingival tissue samples sections embedded in paraffin wax blocks were sent for the detection of HPV by Polymerase chain reaction (PCR). In the present study, conventional PCR was chosen. The gingival tissue samples were selected for the detection of viral DNA as it has been found out that HPV cell cycle have been to be in a close association with the differentiation of the epithelial cells it infects. HPV has the property of infecting the deeper layers of the epithelium and reach the basal layer, without causing any significant lesion as the junctional epithelium connects the gingival sulcus with the connective tissue through a gap in the epithelial barrier. Thus the gingival tissue serve as the reservoir for the virus and release the proinflammatory cytokines. This causes an instability of the cell defense mechanisms and leads to the development of the periodontitis (16). Also in a study by Madinier I et al., have shown various genotypes of HPV i.e. 6, 11, and or 16 have been detected by southern blot in 30% of the gingival specimens involved in the acute gingivitis or periodontal diseases without recognized clinical manifestations of viral infections (17).

A number of studies have been done off late, to illustrate if any correlation and association of these entities. studies by Ali A et al., (18), Salah El-Dein G et al., (19) have found and thus proved a feeble association between chronic periodontitis and HR-HPV( high-risk HPV) infection. The association of chronic periodontitis with OSCC indicate poor oral hygiene as an important risk factor in its aetiology. Chronic infection therefore has both direct and indirect effects in causing carcinogenesis i.e. through toxic effect of microorganisms and through inflammation respectively (20).

In the present study, no significant association and correlation could be established between Chronic Generalized Periodontitis (CGP) and different stages of OSCC. The result of this study is similar to a study by Virtanen E et al., (21) in which out of 286 patients with chronic periodontitis when followed over a period of 24 years, only 18 developed cancer.

In this study, the authors have found that out of 15 CGP patients HPV was present in the tissue sample of only 4 patients. The results of the present study confirm the previous study by Jacob A et al., (22) wherein they could not establish any association of HPV and chronic periodontitis. The reason for such non-significant association could be attributed to the small sample size. In a systematic review by Ortiz AP et al., the rate of the occurrence of HPV in periodontitis patients was more likely to present in patients with severe periodontitis in contrast to patients with mild form of periodontitis the percentage of association was significantly lower (23).

Neither a significant association nor correlation could be established between the HPV status and OSCC staging. Out of 15 patients, 4 patients with HPV positive status were distributed in different stages of OSCC i.e. stage I,II,III. The present study results confirm the results of some previous studies (24),(25),(26) describing the association of HR-HPV (high-risk human papilloma virus) status. In another study, by Lingen MW on oral squamous cell carcinoma patients, 24 cases reported to be HPV positive out of 409 studied cases (27) which was found to be non-significant. Also study by Reuschenbach M et al., in 2013 a lack of evidence of HPV attributable fraction by ISH (in-situ hybridisation) in OSCC patients indicated a poor association and correlation between HPV induced OSCC. The study found that out of 275 OSCC patients, 69 patients tested positive by PCR-EIA (Enzyme Immunoassay) whereas ISH was found to be negative in all of them which is in accordance with the present study (28).

Limitation(s)

Small sample size, and a short duration of the study were the main limitations.

Conclusion

In this study, a significant association and correlation between patients with chronic periodontitis, oral squamous cell carcinoma and HPV, was not established. A link between OSCC and poor oral hygiene has been suggested over two decades, but a clear mechanism between the two is not understood. HPV which is one of the most important aetiological factor in the causing OSCC, and the same time chronic inflammation of the periodontium also increases the probability of causing OSCC. A proper connection between the oral HPV and periodontitis is not yet established, whether it is through the direct effects of bacteria or through stimulation of inflammation is yet to be determined. Hence studies with larger sample size needs to be conducted.

References

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Moergel M, Kämmerer P, Kasaj A, Armouti E, Alshihri A, Weyer V, et al., Chronic periodontitis and its possible association with oral squamous cell carcinoma-a retrospective case control study. Head Face Med. 2013;9:9-39. Doi: 10.1186/1746-160X-9-39. [crossref] [PubMed]
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Tezal M, Sullivan Nasca M, Stoler DL, Melendy T, Hyland A, Smaldino PJ, et al., Chronic periodontitis-human papillomavirus synergy in base of tongue cancers. Arch Otolaryngol Head Neck Surg. 2009;135(4):391-96. [crossref] [PubMed]
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Sharma M, Bairy I, Pai K, Satyamoorthy K, Prasad S, Berkovitz B, et al., Salivary IL-6 levels in oral leukoplakia with dysplasia and its clinical relevance to tobacco habits and periodontitis. Clin Oral Investig.2011;15(5):705-14. [crossref] [PubMed]
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Guerra L, Guidi R, Frisan T. Do bacterial genotoxins contribute to chronic inflammation, genomic instability and tumor progression? Febs J. 2011;278(23):4577-88. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2023/58178.17419

Date of Submission: Jun 02, 2022
Date of Peer Review: Aug 19, 2022
Date of Acceptance: Nov 02, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 27, 2022
• Manual Googling: Oct 21, 2022
• iThenticate Software: Nov 01, 2022 (11%)

ETYMOLOGY: Author Origin

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