Background and Objectives:Patients with diabetes mellitus are prone to secondary infections. In this study we aim to determine the prevalence of one such secondary infection (oral Candida colonization) and evaluate the influence of local and systemic factors on the oral candidal colonization in patients with diabetes mellitus.Materials and Methods:Forty non-insulin-dependent diabetic patients and 40 healthy individuals were included in this study. Samples were collected by using the oral rinse method. The candidal species were isolated and identified through phenotypic methods. An in vitro antifungal susceptibility profile was evaluated. Glycemic control, as determined by the glycosylated hemoglobin concentrations (HbA1c) of the study subjects, was correlated with the candidal colonization.Results:Patients with diabetes showed a significantly higher prevalence of candidal colonization. The rate of carriage and density (P = 0.001) was higher. Candida albicans was the most predominantly isolated species, however, C. dubliniensis, C. tropicalis, and C. parapsilosis were also observed. Variable resistance toward the antifungal drugs (amphotericin B and fluconazole) was observed in the Candida isolated from diabetics, but not from healthy patients. Interestingly, a positive correlation was observed between glycemic control and candidal colonization.Conclusion:Diabetic patients had a higher candidal carriage rate, with a variety of candidal strains, which significantly varied in their resistance to routinely used anti-fungal agents. Interestingly the higher oral candidal colonization in diabetic patients is related to local and systemic factors, independent of their oral habits.

Background Placenta accreta spectrum (PAS) of disorders is an important cause of post-partum hemorrhage and resultant maternal morbidity and mortality. Imaging plays an indispensable role in antenatal diagnosis of PAS. However, diagnosis of PAS on both ultrasonography and magnetic resonance imaging (MRI) is reliant on recognition of multiple imaging signs each of which have a wide range of sensitivity and specificity. There is no single pathognomonic diagnostic feature. This results in interobserver variability. In our study, we aim to assess the accuracy of a combined clinico-radiological scoring system in predicting placenta accreta. Results This retrospective study included 60 MRI examinations done for suspected placenta accreta (PA). MRI findings were assessed by two radiologists in consensus. Clinical details of the patients were obtained from the hospital information system. Two clinical and six imaging criteria were assessed and a total score was calculated for each patient. Patients were stratified into three groups—low, moderate or high probability for placenta accreta based on the total score. The presence of any statistically significant difference in prevalence of PA among these groups was assessed. Intra-operative findings/histopathology were considered the gold standard. The prevalence of PA was 3% (1/33), 28.5% (2/7) and 90% (18/20) in the low-, moderate- and high-risk groups respectively. There was a statistically significant difference in the prevalence between the three groups (chi-square statistic = 41.54, p value < 0.0001). A score of greater than or equal to 6 provided sensitivity, specificity and accuracy of 85.71, 94.87 and 92.5% respectively in diagnosing placenta accreta. Conclusion PASS provides a simple, objective and accurate way to stratify patients into low, intermediate and high probability categories for PA.

A 42-year-female patient presented with a swelling on the left side of the face for the past 10 years. The radiograph shows multilocular radiolucency with evidence of root resorption. Histopathology reveals fibrous connective tissue exhibiting numerous odontogenic epithelial islands with peripheral tall columnar cells showing a reversal of polarity. The center of the island shows stellate reticulum like cells. The connective tissue also shows the presence of extensive coarse granular eosinophilic cells distributed throughout the section.

Adenoid cystic carcinoma (ACC) is a clinically deceptive and histologically specific malignancy of salivary gland origin. It is the most common minor salivary gland malignancy. Small cell carcinoma (SCC) is a type of undifferentiated malignant neuroendocrine tumor reported rarely in the liver. Though there are many reported cases of SCC involving liver and ACC of minor salivary glands, the review of literature does not show any reports of concomitant occurrence of these two tumors. We describe a rare case of ACC of the oral cavity and its coexistence with a SCC involving liver, identified and confirmed by histological, and immunohistochemical observations. To our knowledge, this is the first reported case of an ACC of the oral cavity and SCC of liver occurring concomitantly in the same patient.

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