Primary central nervous system lymphoma: Comprehension of cell-of-origin subtypes

Primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) is an uncommon extranodal lymphoma that accounts for more than 95% of all the CNS lymphomas. Unlike its systemic/nodal counterpart, which is currently subtyped into cell-of origin (COO) subtypes, its feasibility and utility are largely debatable in PCNS-DLBCL. Objectives: To classify PCNS-DLBCL into COO-subtypes based on immunohistochemical algorithms by Hans and Choi and evaluate concordance between the two. A further aim is to investigate the clinicoradiological and histomorphological parameters of the subtypes thus obtained. Materials and Methods: As many as 143 cases of primary CNS lymphoma were evaluated by immunohistochemistry for CD10, BCL6, MUM1, GCET, and FOXP1 and based on which the said 143 cases were further classified into COO subtypes using Hans and Choi algorithms. Results: Mean age was 53.8 years with marginal male preponderance and predominantly centroblastic morphology (75.5%). CD 10 was positive in 8.9% of the cases, BCL6 in 58.6%, MUM1 in 89.9%, GCET in 32.9%, and FOXP1 in 79.5%. As much as 84.9% cases were of non-germinal center B-cell (GCB) subtype and 15.1% cases were of GCB subtype as determined based on Hans algorithm. Furthermore, 90.7% cases were of activated B-cell (ABC) subtype and 9.3% cases were of GCB subtype according to Choi algorithm. A 91.8% concordance was observed between Hans and Choi algorithms. Among the 6 discordant cases, 5 cases were subtyped as GCB by Hans and ABC by Choi and 1 case as ABC by Hans and GCB by Choi. Conclusion: Most of PCNS-DLBCLs are of non-GCB/ABC COO subtype, but inconsistences abound in the utility of IHC algorithms in PCNS-DLBCL COO subtypes.

Intentional Replantation to Rehabilitate and Preserve the Integrity of Maxillary Central Incisor with Complicated Crown En-masse Fracture.

The present case aims to describe the management of a complicated crown en masse fracture in a maxillary central incisor due to trauma by intentional replantation as the chosen treatment modality. Intentional replantation aiming towards successful endodontic therapy comprises intentional therapeutic extraction of the tooth and an endodontic procedure in a controlled environment followed by replantation. A 24-year-old female patient presented to the department with a chief complaint of broken upper front teeth following trauma. The teeth were tender on percussion. The periapical radiographic examination revealed a complicated fracture involving the pulp without significant periapical changes. A diagnosis of Ellis Class III was established and intentional reimplantation was planned with the patients consent. Following an atraumatic extraction, conventional root canal treatment was completed. Subsequently, a fibre-post was used to reinforce the tooth structure. The tooth was placed back into the socket and splinted. One year of follow up examination revealed absence of pain and periapical healing. The treatment yielded a clinical, aesthetic and functionally satisfactory result, establishing intentional replantation to be a feasible treatment option in complicated crown en masse fracture of the tooth.

Association of UGT1A6 gene polymorphism with clinical outcome in pediatric epileptic patients on sodium valproate monotherapy

Pediatric epilepsy comprises chronic neurological disorders characterized by recurrent seizures. Sodium valproate is one of the common antiseizure medications used for treatment. Glucuronide conjugation is the major metabolic pathway of sodium valproate, carried out by the enzyme uridine 5′-diphosphate (UDP) glucuronosyl transferase (UGT) whose gene polymorphisms may alter the clinical outcome. The objective of this study was to assess the association between UGT1A6 genetic polymorphism and clinical outcome in terms of efficacy and tolerability in pediatric epileptic patients on sodium valproate monotherapy. Pediatric epileptic patients (n=65) aged 2-18 years receiving sodium valproate monotherapy for the past one month were included. Genetic polymorphism patterns of UGT1A6 (T19G, A541G, A552C) were evaluated by PCR-RFLP. Clinical outcome was seizure control during the 6 months observation period. Tolerability was measured by estimating the hepatic, renal, and other lab parameters. Out of 65 patients, TT (40%), TG (57%), and GG (3%) patterns were observed in UGT1A6 (T19G) gene, AA (51%), AG (40%), and GG (9%) in (A541G) gene, and AA (43%), AC (43%), and CC (14%) in (A552C) gene. No statistical difference in clinical outcome was found for different UGT1A6 genetic polymorphism patterns. We concluded that different patterns of UGT1A6 genetic polymorphism were not associated with the clinical outcome of sodium valproate in terms of efficacy and tolerability. Sodium valproate was well-tolerated among pediatric patients with epilepsy and can be used as an effective antiseizure medication.

Design And Characterization Of Mucoadhesive Microspheres Of Etodolac

Mucoadhesive microspheres are drug delivery system intended for targeting a drug to particular region. Etodolac is a Non-steroidal anti-inflammatory drug. The objective of the present work was to develop sustain release of Etodolac loaded mucoadhesive microspheres due to relatively short residence time in the GIT tract before elimination. Mucoadhesive microspheres were prepared by non-aqueous solvent evaporation method using Carbopol 974P, HPMC K100M and HPMC K4M as the polymers. Central composite design was selected for the development of the formulation. Evaluation parameters like particle size, entrapment efficiency, shape and surface morphology, degree of swelling, drug content, in-vitro drug release study and in-vitro drug release study was done. Based on the results obtained from the preliminary formulations three optimized formulations were designed. The percentage mucoadhesion and swelling index of the optimized formulation was found in the range of 66-70 % and 82.50-83.84 % respectively. Optimized formulation releases 90.94% to 92.11% of drug at the end of 10 hours and follows zero order release kinetics.

Trend of human brucellosis over a decade at tertiary care centre in North Karnataka.

Background: Brucellosis is an important zoonotic disease. India having a major agrarian population is expected to have a higher prevalence. However, due to lack of laboratory facility or awareness among clinicians, the disease is largely underreported. The aim of this study was to know the prevalence and trend of human brucellosis over a decade, in patients attending a teaching hospital in North Karnataka, and to understand their geographical distribution. Materials and Methods: The study was conducted from January 2006 to December 2015 at a tertiary care teaching hospital in North Karnataka. A total of 3610 serum samples were evaluated from suspected cases of brucellosis. All serum samples were initially screened by Rose Bengal plate test, and positive samples were further analysed by Serum agglutination test (SAT) using standard Brucella abortus antigen from Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India. A titre above or equal to 1:80 IU/ml was considered as positive. Demographic data such as age, sex and native place of these patients were also analysed. Results: We observed that human brucellosis is present in North Karnataka. The overall seropositivity of brucellosis in suspected cases was 5.1%. The positive titres ranged from 1:80 to 163,840 IU/ml. The majority of the patients were from Gadag, Koppal and Haveri districts of North Karnataka. Conclusion: Our study confirms the presence of human brucellosis in the northern part of Karnataka. Further studies to understand the prevalence of animal brucellosis in these areas will help in implementing prevention measures.

A new approach to exfoliative cytology: A comparative cytomorphometric study.

CONTEXT: Early detection of oral premalignancy and malignancy using simple screening aids play a promising role in curbing the disease. AIM: The primary aim of this study is to evaluate and the secondary aim of this study is to compare the cytomorphometry and cellular atypia in keratinocytes obtained from oral rinse and conventional exfoliative cytology in normal oral mucosa and clinically diagnosed oral leukoplakia. MATERIALS AND METHODS: The study comprised of 55 clinically diagnosed cases of leukoplakia and 55 age and sex matched normal controls. Smears were prepared using oral rinse technique followed by the conventional exfoliative cytology. Papanicoloau stained smears were evaluated for atypia and subjected to image analysis. Based on the presence of atypia they were further divided into three groups (Group 1‑cases with atypia, Group 2‑without atypia and Group 3‑normal controls) and analyzed. Statistical analysis used one‑way analysis of variance followed by Tukey Honestly Significant Difference test for intergroup analysis and unpaired students t‑test to compare the two methods. RESULTS: Smears prepared with both methods demonstrated atypia in 18 cases. The cellular diameter and cellular area (CA) were progressively increased from Group 1 through Groups 2 and 3 in both the smears. Nuclear diameter and nuclear area and nuclear cytoplasmic ratio progressively decreased from Group 1 through Groups 2 and 3. Both the methods showed no significant differences among the cellular parameters except in normal controls. CONCLUSION: Cytomorphometric analysis of keratinocytes obtained with oral rinse method and wooden spatula can serve as a useful screening aid to detect oral leukoplakia. Oral rinse method being more convenient results in smears of better quality.

Menstrual Cycle Related Changes In Human Whole Salivary pH And Salivary Leukocyte Count.

Introduction: Steroid sex hormones influence every system of the body including the oral cavity. It influences the composition and flow rate of saliva. The aim was to estimate the changes in human whole salivary pH and salivary leukocyte count during the various phases of menstrual cycle. Materials and method: 30 female patients between 18-35 years were included in the study. They were free from any systemic illness or medication. Unstimulated saliva was collected between 10AM and 11AM during the follicular (7th day), ovulatory (12th-14th days), and luteal (21st day) phases and evaluated for changes in salivary pH and leukocyte count. Result: The salivary pH showed significant difference in value between ovulatory and luteal phase while the salivary leukocyte count showed significant difference in values during all the three phases. Conclusion: Steroid sex hormones do influence the composition of saliva and thus influence the health of periodontal tissues indirectly.

Focal fibrous hyperplasia: a case report

Fibromas are the benign tumours that are most commonly encountered among the oral soft tissue lesions. They are mostly seen as a protective mechanism of the mucosa towards chronic irritation. They present clinically as a round or ovoid, soft to firm in consistency, exophytic growth, mostly pale pink in colour with smooth surface. These lesions are asymptomatic and do not require any treatment until bothersome to the patient. The clinical features, histopathological features and treatment of an irritational fibroma occurring on the hard palate of a 32 year old female are presented.

Capdepont’s teeth: a case report

Dentinogenesis imperfecta is an autosomal dominant disorder of tooth development characterized by the presence of opalescent dentine, resulting in a dusky blue to brownish discoloration of the teeth. It is the most common dental genetic disease. This condition is genetically and clinically heterogeneous, it may affect only the teeth or it may be associated with the osteogenesis imperfecta. Diagnosis is based on history, clinical examination and radiographic features. This report describes an 18 year old male patient who showed the characteristic dental features of dentinogenesis imperfecta.

Oral mucocele treated using diode laser: a case report

The mucocele is a salivary gland pathology that results from rupture of salivary gland duct and spillage of mucin into the surrounding tissues. The term mucous extravacation is also used to describe this lesion. The rupture of the gland or duct may be due to local trauma. The most common site of mucocele is lower lip. The treatment of mucocele includes cryosurgery , intra-lesional corticosteroid injection, micro-marsupialization, marsupialization of the mucocele, conventional surgical removal of the lesion , and laser ablation. The advantages of laser ablation over other methods include less treatment time, avoidance of suturing, minimal complications and relapse. Here we report a case of mucocele on lower lip treated using diode laser.

Dentoalvolar abscess with extra oral sinus in a pediatric patient: a case report

Cutaneous sins tract of dental origin are often misdiagnosed and inappropriately treated because of their uncommon occurrence and absence of symptoms in about half of the patients. A case report describing the diagnosis and treatment of an extra oral cutaneous sinus tract of odontogenic origin in relation to mandibular left first molar with surgical treatment and proper antibiotic coverage is presented.

Denture induced inflammatory hyperplasia – a case report

Epulis fissuratum is a benign tumor like inflammatory hyperplastic growth which occurs on the mucosa along the borders of an ill fitting full or partial removable denture. If ulcerated, it can mimic oral squamous cell carcinoma. The treatment includes surgical removal of excess fibrous tissue and remodelling or reconstructing the denture suitably, ensuring better adaptability to the ridges. This case report describes a 55 year old male patient with characteristic clinical features of denture induced inflammatory hyperplasia.

Eruption cyst: a case report

Eruption cyst (EC) is a benign cyst associated with a primary or permanent tooth in its soft tissue phase after erupting through the bone. It is most prevalent in the Caucasian race. It is clinically significant in that knowledge among general dentists is very essential regarding this developmental disturbance to reach the correct diagnosis and to provide proper treatment. We are reporting a case of eruption cyst in an 11 year old boy.

Present and Future Climate Change in Indian Cardamom Hills: Implications for Cardamom Production and Sustainability.

Aims: This paper examines the interactions between climate parameters and cardamom capsule yield and its sustainability in Indian Cardamom Hills. Methodology: Temporal trends were evaluated at annual, seasonal and monthly time scale using Mann-Kendall method. Significant trends were identified at annual, seasonal and monthly scale using two tailed Z-Test. The temporal trends were evaluated using the non-parametric Mann-Kendall test. To quantify the slope we used Sen’s non-parametric estimator of slope. The significance of the test was evaluated using two tailed Z-Test. A p value of <0.05 was used to indicate statistical significance, using two tailed Z test. Results: Climate warming was significant in the recent decades in the Indian Cardamom Hills, which is recognized as one of the ecologically sensitive and biologically diverse areas. Considerable and significant spatial and temporal variations have occurred in the main climatic elements like air temperature, rainfall and relative humidity in the hill region. Significant positive trend in day-night time temperature has been observed and the trend differed from one station to another. Significant increasing trend was also observed for minimum temperature than maximum temperature and this had caused decline in diurnal temperature. Both winter and summer monsoon rainfall as well as high relative humidity had a positive influence on the yield of cardamom. However, the variability in these two types of rainfall was high for the entire region and the trend is negative. The variability of monthly mean precipitation is high for May, December and January under AR4 climate scenario. Conclusion: The sustainable yield of cardamom may be possible only when the winter and summer rainfall variabilities were minimal. Increasing trend of soil temperature from 0-10 cm depth was recorded, which was significant at 5 cm depth and can cause considerable negative implications for sustainable cardamom production both in terms of reduced soil moisture availability and altered pest population dynamics.

Association of platelet count and serological markers of dengue infection- importance of NS1 antigen.

Introduction: Dengue is an acute viral infection with potential fatal complications. Specific antibody detection has been the mainstay of diagnosis which is prone for both false positive and false negative reactions. The newer parameter NS1 appears to be highly specific and reliable for diagnosis of dengue infection from the first day of fever. Platelet count is the only accessory test for diagnosis of dengue infection in the peripheral laboratories. Therefore, we tried to evaluate the association of platelet counts against NS1 and IgM/IgG in dengue infections. Materials and Methods: Serum samples from clinically suspected dengue cases were tested for NS1, IgM and IgG by immunochromatography-based test. Platelet counts were obtained for all positive cases and 150 dengue seronegative cases of fever that served as controls. Test results of dengue-specific parameters were compared against platelet counts. The proportions obtained were compared by Standard error of the difference between the proportions (SEP test). Results: Of 2104 samples tested, 320 were positive for one or more dengue parameters. Of the 320, 95 were positive for NS1 only, 161 showed IgM only while 9 showed IgG only. More than one marker was detected in the remaining 55 samples. Thrombocytopenia was more consistently associated whenever NS1 was detected compared to antibody detection (P value <0.001). Conclusions: Inclusion of NS1 in the diagnosis of dengue increases the detection rate significantly. In cases of fever, thrombocytopenia is more consistently found in dengue positive rather than dengue negative subjects. It correlates well when NS1 and IgM are detected simultaneously.

Ocular prosthesis in children--clinical report.

Children and adolescents are particularly susceptible to injuries because of their fearless manner of play and their athletic immaturity due to which irreparable trauma to the eye is very commonly seen. Glaucoma is another common cause for eye loss in children. The loss of an eye causes disfigurement of the face due to which the children become emotionally weak and conscious and avoid taking part in social events, which in turn causes anxiety, stress and depression at an early age in life. Recovery after the loss of an eye requires an adjustment to monocular vision and improvement of the appearance with the use of artificial eyes carefully prepared to match the remaining natural eye. The custom made ocular prostheses are very comfortable and help children improve their appearances, which in turn, encourages them to build up their self-confidence to return back to their social life.