Serotypes & penicillin susceptibility of Streptococcus pneumoniae isolated from children admitted to a tertiary teaching hospital in Malaysia

Background & objectives: Streptococcus pneumoniae (pneumococcus) is a highly invasive extracellular pathogen that causes diseases such as pneumonia, otitis media and meningitis. This study was undertaken to determine the serotype diversity and penicillin susceptibility of S. pneumoniae isolated from paediatric patients in a tertiary teaching hospital in Malaysia. Methods: A total of 125 clinical isolates collected from January 2013 to May 2015 were serotyped using seven sequential multiplex polymerase chain reactions. The susceptibility of these isolates to penicillin was also investigated. Results: Serotypes detected among the isolates were serotypes 3, 6A/B, 6C, 11/A/D/F, 15A/F, 19A, 19F, 23A, 23F, 34. Serotypes 19F and 6A/B were the most prevalent serotypes detected. Most of the S. pneumoniae were isolated from nasopharyngeal samples of children below five years of age. Majority of the isolates were penicillin susceptible. Only 5.6 per cent of the isolates were non-susceptible to penicillin, mostly of serotype 19F. Interpretation & conclusions: Our study revealed the distribution of various serotypes in S. pneumoniae isolates obtained from children in a teaching hospital at Kuala Lumpur, Malaysia and decreasing rates of penicillin resistance among them. The shifts in serotypes and susceptibility to penicillin from time to time have been observed. Continuous monitoring and surveillance are pivotal for better infection control and management of pneumococcal infections among children.

Characterization of cryptic rearrangements, deletion, complex variants of PML, RARA in acute promyelocytic leukemia.

Acute promyelocytic leukemia (APL) is characterized by a reciprocal translocation t(15;17)(q22;q21) leading to the disruption of Promyelocytic leukemia (PML) and Retionic Acid Receptor Alpha (RARA) followed by reciprocal PML–RARA fusion in 90% of the cases. Fluorescence in situ hybridization (FISH) has overcome the hurdles of unavailability of abnormal and/or lack of metaphase cells, and detection of cryptic, submicroscopic rearrangements. In the present study, besides diagnostic approach we sought to analyze these cases for identification and characterization of cryptic rearrangements, deletion variants and unknown RARA translocation variants by application of D-FISH and RARA break-apart probe strategy on interphase and metaphase cells in a large series of 200 cases of APL. Forty cases (20%) had atypical PML–RARA and/or RARA variants. D-FISH with PML/RARA probe helped identification of RARA insertion to PML. By application of D-FISH on metaphase cells, we documented that translocation of 15 to 17 leads to 17q deletion which results in loss of reciprocal fusion and/or residual RARA on der(17). Among the complex variants of t(15;17), PML–RARA fusion followed by residual RARA insertion closed to PML–RARA on der(15) was unique and unusual. FISH with break-apart RARA probe on metaphase cells was found to be a very efficient strategy to detect unknown RARA variant translocations like t(11;17)(q23;q21), t(11;17)(q13;q21) and t(2;17)(p21;q21). These findings proved that D-FISH and break-apart probe strategy has potential to detect primary as well as secondary additional aberrations of PML, RARA and other additional loci. The long-term clinical follow-up is essential to evaluate the clinical importance of these findings.

Sarcomatoid salivary duct carcinoma of minor salivary gland: A rare case.

A 35-year-old female presented with swelling in the soft palate. Fine needle aspiration cytology (FNAC) revealed pleomorphic adenoma, and on histopathological examination, it was diagnosed as carcinosarcoma/salivary duct carcinoma in the minor salivary gland, which was confirmed by immunohistochemical stains. We report this case for its rarity.

Papillon-Lefevre syndrome: a case report.

Papillon-Lefevre syndrome is a rare autosomal recessive genetic disorder. The clinical manifestations include palmer planter hyperkeratosis with precocious progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. This is a case report of prosthodontic rehabilitation of a 15-year-old girl with Papillon-Lefevre syndrome.

Retention of a resin-based sealant and a glass ionomer used as a fissure sealant: a comparative clinical study.

Sealing occlusal pits and fissures with resin-based sealants is a proven method of preventing occlusal caries. Retention of the sealant is very essential for its efficiency. This study evaluated the retention of glass ionomer used as a fissure sealant when compared to a self-cure resin-based sealant. One hundred and seven children between the ages of 6-9 years, with all four newly erupted permanent first molars were selected. Two permanent first molars on one side of the mouth were sealed with Delton, a resin-based sealant, and the contralateral two permanent first molars were sealed with Fuji VII glass ionomer cement. Evaluation of sealant retention was performed at regular intervals over 12 months, using Simonsen's criteria. At the end of the study period, the retention of the resin sealant was seen to be superior to that of the glass ionomer sealant.

Dentinogenesis imperfecta: A case report.

Dentinogenesis imperfecta is an autosomal dominant disorder of tooth development characterized by the presence of opalescent dentin, resulting in a dusky blue to brownish discoloration of the teeth. This condition is genetically and clinically heterogeneous; it may affect only the teeth or it may be associated with the osteogenesis imperfecta. Dentinogenesis imperfecta has been subdivided into three types: type I is associated with osteogenesis imperfecta; in type II there is no associated osteogenesis imperfecta; and when the condition is associated with the Brandywine triracial isolate and large pulp chambers it is classified as type III. This report describes a 16-year-old female patient who showed the characteristic dental features of dentinogenesis imperfecta type II. The etiology and prevalence of the disorder, and a comprehensive treatment plan, will be briefly reviewed.

Witkop's tooth and nail syndrome: a multifaceted approach to dental management.

Witkop's tooth and nail syndrome is a rare autosomal dominant disorder of ectodermal dysplasia characterized by hypodontia and nail dysplasia. Mutations in MSX-1 have been shown to be associated with this syndrome. There is failure of development and eruption of the dentition. Tooth shape may vary; the most common forms are conical and narrow crowns. The nails may be spoon shaped and slow growing and affect both finger and toe nails. The nail involvement is more severe in childhood. The present case describes a 14-year-old boy who showed the characteristic features of Witkop's syndrome. A multifaceted approach to the dental management of the patient is discussed.

Glass fiber-reinforced composite resin as a space maintainer: a clinical study.

The aim of this study is to evaluate the use of glass fiber-reinforced composite resin (GFRCR) as a space maintainer and to compare it with a conventional band-and-loop space maintainer. A total of 30 children (23 boys and 7 girls) aged 6-8 years were selected for the study. Each of these children required maintenance of space due to premature loss of primary first molars in at least two quadrants. In one quadrant, a GFRCR space maintainer was applied and in the other quadrant a band-and-loop space maintainer was cemented. Patients were recalled at regular intervals over 12 months and retention of both the types of space maintainers was evaluated. The retention of the GFRCR space maintainer was found to be superior to that of the band-and-loop space maintainer, but this difference was not statistically significant.

An in vitro evaluation of pH variations in calcium hydroxide liners.

The purpose of this present study was to determine the pH changes of five different commercially available calcium hydroxide liners and variations of pH at different time intervals. The following commercially available materials were investigated: Dycal (LD Caulk); Calcimol (Vocco Products); calcium hydroxide powder (Deepti Products); Calcimol LC (Vocco Products); Lime-Lite (Pulpdent Corporation). Five samples were prepared from each liner. The pH measurements were recorded at time intervals of 1 h, 24 h, 3 days and 7 days after mixing of the liner. The pH variations of each material at the given time intervals were recorded and the means were calculated. Comparison of the mean values at all time intervals with the statistical analysis showed significantly high differences (P < 0.001) between pH values induced by each material at all time intervals. Among the water-insoluble products, Dycal had the strongest alkaline effect after 7 days interval. The materials that chemically hardened produced higher pH values than materials that hardened by a visible light source after 7 days.

The prevalence and pattern of wife beating in the Trincomalee district in eastern Sri Lanka.

A descriptive cross-sectional study was carried out to determine the prevalence and to identify some socio-demographic factors associated with wife beating in the Medical Officer of Health (MOH) area of Kantale in the Trincomalee district of eastern Sri Lanka. A random sample of 417 women in the age category 18-49 years constituted the sample population. Data were obtained by focus group discussions followed by the administration of a structured questionnaire by trained interviewers. The prevalence of reported wife beating among ever-married women was 30% and the prevalence of wife beating in the year preceding the study was 22%. There was no significant association between wife beating and ethnicity of the study population or a particular age group of either the batterer or the victim. Moreover, wife beating was associated with an early age at marriage for women, low-income, a low standard of living index, large families and alcohol consumption by the batterer. A significant inverse relationship between domestic violence and the level of education of both the batterer and the victim was also identified. Contusions, typically distributed in the region of the head, face and neck were found to be the commonest type of injury suffered by battered women. A majority of women, irrespective of their level of education and employment status placed the welfare of their children as the prime reason for continuing to stay in an abusive relationship. The study concludes that wife beating is a serious health and social problem for the women population of Kantale. Intervention is recommended in relation to key issues identified by the study, including alcohol abuse by men, relative lack of education among the population, lack of family planning, societal influences promoting teenage marriages of the girl-child and absence of programs aimed at creating awareness on wife beating.

Risk factors for coronary artery disease and levels of lipoprotein(a) and fat-soluble antioxidant vitamins in Asian Indians of USA.

High rates of coronary artery disease have been reported in the Asian Indians who have migrated to other countries. Although many coronary artery disease risk factors (diabetes, high serum cholesterol, lipoprotein[a], and smoking) have been suggested, studies of coronary artery disease risk factors in Asian Indians living in USA are only a few. We investigated coronary artery disease risk factors in 110 Asian Indian physicians living in USA by questionnaire and measurement of their serum lipids and fat-soluble antioxidant vitamins. Differences in risk factors between genders, vegetarian diets and diabetic status were also studied. We found that lipoprotein(a) (mean=20 mg/dl), low density lipoprotein cholesterol, and diabetes (prevalence of 7.5%) are more important risk factors for coronary artery disease, but not smoking, when compared to other Americans. Higher levels of low density lipoprotein cholesterol, retinol, alpha-tocopherol, cryptoxanthin and lycopene, and lower levels of high density lipoprotein cholesterol were found in the males than in females. Comparable levels of lipoprotein(a) were found for males and females. Vegetarians, compared to non-vegetarians, had similar levels of lipids and fat-soluble antioxidants. Lower levels of retinol, lutein/zeaxanthin and lycopene were found in the diabetics compared to non-diabetics. These findings suggest that (1) the control of low density/high density lipoprotein cholesterol levels could be important in prevention of coronary artery disease in Indian males, (2) the vegetarian diets of Asian Indians do not favourably influence the serum lipid and antioxidant levels, and (3) increased serum levels of antioxidants may be beneficial for diabetics. Furthermore, for the first time, we show that serum levels of lutein/zeaxanthin and lycopene are significantly lower in the diabetics.