Ranula – threefold habituation.

Intraoral swellings present as a diagnostic challenge to the clinician, the most bourgeois being mucocele & ranula. An intraoral ranula has been defined as a retention cyst due to ductal obstruction & fluid retention of the sublingual salivary gland on the floor of the mouth. The name “ranula” has been derived from the latin word “Rana” meaning “Frog.” We hereby report a case of triennial recurrent ranula located in the floor of mouth, treated successfully by surgical excision by injecting an irreversible impression material to delineate the cystic lining of the lesion, after which the patient recovered unvariedly.

Practice patterns of neurology in India: fewer hands, more work.

BACKGROUND: India is a populous country housing over a billion people. Neurology as a specialty is being practiced in India for over 50 years but the number of physicians devoted to fulltime neurology is limited. This fact coupled with the privatized healthcare system and limited infrastructure has led to situations different from the more developed healthcare systems. AIM: To study the practice patterns of neurology in India. SETTING AND DESIGN: Questionnaire-based study. MATERIALS AND METHODS: Questionnaire was sent to 250 members of the Indian Academy of Neurology [sample size approximately 25%] using random number table. The responses were tabulated and analyzed. RESULTS AND CONCLUSIONS: The neurology group is small and hence is exposed to a large workload. The average number of patients seen daily by Indian neurologists is three to four times those seen by the United States and United Kingdom neurologists. Neurologists based at district places are more likely to see direct patients; whereas metropolitan neurologists see more referrals. Investigative facilities are available to neurologists but affordability is a concern. Clinical work leaves less time for academic and research activities, which the consultants are keen to participate in. In the privatized health system of India, emergency work constitutes a difficult area to cope with. The concept of single specialty group practice is welcomed by the majority with the idea of streamlining their work and life. These factors highlight an urgent need for increasing the neurology work force and argue for further involvement of primary physicians and internists in neurological care in India.

Donor corneal tissue evaluation.

Proper evaluation of donor cornea is critical to the success of corneal transplantation. Attention must be paid to the cause of death and ocular condition as several general and ocular diseases constitute contraindications for donor corneal usage. Death to enucleation time should be noted. Gross examination and slit lamp biomicroscopy are mandatory for the evaluation of the donor eye while specular microscopy adds another useful dimension to information regarding donor cornea. This article provides a comprehensive review of all the aspects of donor corneal evaluation as practised today worldwide.

Mode of action of lipoic acid in diabetes.

Metabolic aberrations in diabetes such as hyperglycemia, ketonemia, ketonuria, reduced glycogen in tissues and reduced rates of fatty acid synthesis in the liver are corrected by the administration of lipoic acid. Dithiol octanoic acid is formed from lipoic acid by reduction and substitutes for Coenzyme A in several enzymatic reactions such as pyruvate dehydrogenase, citrate synthase, acetyl Coenzyme A carboxylase, fatty acid synthetase, and triglyceride and phospholipid biosynthesis; but not in the oxidation of fatty acids because of the slow rates of thiolysis of ß-keto acyl dithioloctanoic acid. The overall effect of these changes in the key enzymic activities is seen in the increased rates of oxidation of glucose and a reduction in fatty acid oxidation in diabetes following lipoic acid administration.

Lipoic acid and diabetes—Part III: Metabolic role of acetyl dihydrolipoic acid.

Rat liver lipoyl transacetylase catalyzes the formation of acetyl dihydrolipoic acid from acetyl coenzyme A and dihydrolipoic acid. In an earlier paper the formation of acetyl dihydrolipoic from pyruvate and dihydrolipoic acid catalyzed by pyruvate dehydrogenase has been reported. Acetyl dihydrolipoic acid is a substrate for citrate synthase, acetyl coenzyme A carboxylase and fatty acid synthetase. The Vmax. for citrate synthase with acetyl dihydrolipoic acid was identical to acetyl coenzyme A (approximately 1 μmol citrate formed/min/mg protein) while the apparent Km was approximately 4 times higher with acetyl dihydrolipoic acid as the substrate. This may be due to the fact that synthetic acetyl dihydrolipoic acid is a mixture of 4 possible isomers and only one of them may be the substrate for the enzymatic reaction. While dihydrolipoic acid can replace coenzyme A in the activation of succinate catalyzed by succinyl coenzyme A synthetase, the transfer of coenzyme A between succinate and acetoacetyl dihydrolipoic acid catalyzed by succinyl coenzyme A: 3 oxo-acid coenzyme A transferase does not occur.

Lipoic acid and diabetes II: Mode of action of lipoic acid.

Intraperitoneal administration of lipoic acid (10 mg/100 g) does not effect changes in serum insulin levels in normal and alloxan diabetic rats, while normalising increased serum pyruvate, and impaired liver pyruvic dehydrogenase characteristic of the diabetic state. Dihydrolipoic acid has been shown to participate in activation of fatty acids with equal facility as coenzyme A. Fatty acyl dihydrolipoic acid however is sparsely thiolyzed to yield acetyl dihydrolipoic acid. Also acetyl dihydrolipoic acid does not activate pyruvate carboxylase unlike acetyl coenzyme A. The reduced thiolysis of ß-keto fatty acyl dihydrolipoic acid esters and the lack of activation of pyruvic carboxylase by acetyl dihydrolipoic acid could account for the antiketotic and antigluconeogenic effects of lipoic acid.