Toll-like receptor 2-mediated downstream cytokine levels as determinant of malaria pathogenesis

Background & objectives: Toll-like receptors (TLRs) are transmembrane proteins that recognize specific molecular patterns and activate downstream cytokine production usually for the eradication of invading pathogens. The objective of this study was to evaluate the genetic polymorphism of TLR2 Arg753Gln (rs 5743708) and soluble cytokines and TLR2 expression levels in malaria disease cases. Methods: The study included prospectively collected 2 ml blood samples from 153 individuals clinically suspected for malaria and confirmed by microscopy and RDT from Assam. Stratification of the study groups was done as healthy control (HC, n=150), uncomplicated malaria (UC-M, n=128) and severe malaria (SM, n=25). The PCR-restriction fragment length polymorphism (RFLP) method was applied for the analysis of TLR2 Arg753Gln polymorphism and following the ELISA for soluble serum TLR2 (sTLR2) and its associated downstream cytokines, viz. tumour necrosis factor (TNF)-? and interferon (IFN)-? levels. Results: Variation in TLR2 Arg753Gln gene showed no association with the susceptibility and the severity of malarial infection. Soluble TLR2 expression was significantly higher in uncomplicated malaria (UC-M) cases compared to healthy controls (P=0.045) and in terms of SM cases, the expression was also found to be higher in UC-M cases (P=0.078). The TNF-? expression was significantly higher in SM cases compared to both UC-M and control (P=0.003 and P=0.004). Similarly, significantly elevated expression of IFN-? was noted in SM cases compared to both UC-M (P=0.001) and healthy controls (P<0.001). Interpretation & conclusions: The present study suggests the association of deregulated TLR2 pathway that leads to the deleterious downstream immune response in the development of malarial pathogenicity.

Imaging resemblance but diagnostic disparity in cervix cancer: a rare case report

F-18 FDG PET-CT is an establish modality for staging of cervical cancer. The high uptake value in PET with no evidence of necrosis in CECT is generally understood malignant pathology in known cancer patients. A 47 year-old-female with cervix carcinoma underwent staging FDG PET-CT. It showed FDG avid primary lesion in cervix with FDG avid pelvic, retroperitoneal, mediastinal and supraclavicular lymph nodes. USG guided FNA from the supraclavicular lymph node revealed tuberculosis. Now patient scheduled for ATT and chemotherapy.

Unusual metastatic sex cord stromal tumor - staging and response assessment

Metastatic sex cord stromal tumor (SCST) is rare and contributing <1% of ovarian tumors. A 42-year-old female presented with lower abdominal pain for 2 months. Ultrasonography revealed masses in the abdominal and pelvic. USG guided biopsy from the pelvic mass revealed SCST. For staging, whole body F-18 fluorodeoxyglucose positron emission tomography-computed tomography was performed and revealed heterogenous mildly FDG avid retroperitoneal and bilateral pelvic masses with lung nodules. To confirm the nature of the lung nodule; PET-CT guided biopsy performed and revealed metastatic SCST. After three cycle of chemotherapy, clinical, biochemical and imaging show partial response to treatment.

Real Time F-18 FDG PET-CT-Guided Metabolic Biopsy Targeting Differential FDG Avidity in a Pulmonary Blastoma / 대한핵의학회잡지

Pulmonary blastoma (PB) is a rare thoracic malignancy and preoperative diagnosis is challenging. A young man presented with dyspnea and chest pain for 3–4 months and chest-computed tomography (CT) revealed large mass in the left lung upper lobe and pleural effusion. Repeated CT-guided fine-needle aspiration cytology from the lesion and pleural fluid aspiration was negative for malignancy. F-18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) revealed heterogeneous tracer avidity in left lung mass with areas of necrosis. Real-time PET-CT-guided biopsy from metabolically active component of the lesion revealed biphasic PB on histopathology.

Do accessory parameters affect the outcome of the endoscopic procedures in female infertile patients?: an experience at a single tertiary care center

Background: In modern era, endoscopic methods are commonly used in evaluation of female infertility. Hysterolaparoscopy is such a real time theranostic modality for anatomical causes of the infertility. The objective of this study was to evaluate the effect of accessory parameters (Age, Body mass index, duration of infertility, Rhesus factor, menstruation history and hemoglobin) on success rate of endoscopic procedures in terms of achieving pregnancy.Methods: A total 157 female infertile patients (Mean± standard deviation 27.72±3.82 years) were recruited in present study. During initial assessment detailed history was taken and hysterolaparoscopy was performed. The observed structural abnormalities on hysterolaparoscopy during diagnostic work up were tackled at same time if possible. After procedure, patients were counselled for regular sexual activity. The follow-up of all patients was done for 12 months.Results: A total 157 female infertile patients were recruited and divided into primary 93 (59.2%) and secondary infertile 64 (41.74%) patients on basis of obstetric history. The average age, BMI, hemoglobin and duration of infertility were 27.7years, 21.8 kg/m2, 12.3 gm and 3.9 years respectively. Out of 157 patients, anatomical abnormalities were detected in 125 patients during Hysterolaparoscopy and distributed in 77/93 (82.8%) primary and 48/64 (75%) secondary infertile patients. Of 125 patients with abnormal hysterolaparoscopic findings, 121 underwent active intervention and on follow up, 43 patients were conceived. We found that age; BMI, Rhesus factor, menstruation history and duration of the infertility were not correlated with fertility outcome while hemoglobin level was significantly correlated with conception rate.Conclusions: Authors concluded that outcome of the hysterolaparoscopy in female infertile patients is significantly depends upon hemoglobin levels, however outcome is irrelevant to age, duration of infertility, Rhesus factor and body mass index.

A rare case of duodenal carcinoid presenting as ectopic Cushing’s syndrome

ACTH-dependent Cushing syndrome (CS) due to an ectopic source is responsible for approximately 10-15% cases of Cushing’s syndrome. It is associated with various tumors such as small cell lung cancer and well-differentiated bronchial or gastrointestinal neuroendocrine tumors. Many a times ectopic ACTH production is difficult to manage, and identification of the source may take many years. Hormonal diagnostics include assessments in basic conditions as well as dynamic tests, such as the high-dose dexamethasone suppression test and corticotrophin releasing hormone (CRH) stimulation test. Treatment selection depends on the type of tumor and its extent. In the case of neuroendocrine tumors, the main treatments are surgery and administration of somatostatin analogues or bilateral adrenalectomy in refractory cases and if the source remains unidentified. Here, we report a case who presented with features of Cushing’s syndrome which eventually through workup led us to a diagnosis of duodenal carcinoid producing ectopic ACTH which is extremely rare and was successfully treated.

A clinical and microbiological profile of urinary tract infection in patients with chronic kidney diseases

Background: Urinary tract infections (UTIs) are a major public health problem in terms of morbidity and financial cost in CKD patients in India. The resistance pattern of community acquired uropathogens in CKD patients has not been extensively studied. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community acquired UTIs.Methods: It is a cross sectional study conducted in a tertiary care hospital involving 65 chronic kidney disease patients with UTI who attended general medicine OPD and those admitted in wards after fulfilling the inclusion and exclusion criteria, after obtaining written informed consent. Blood sample and urine samples were collected from these patients and sent for blood analysis, urine analysis and urine culture and sensitivity.Results: Among 65 CKD participants with UTI who were studied, E. coli (47.7%) and K. pneumoniae (15.4%) were the most common isolates which were sensitive in order of colistin, polymyxin B, meropenem (carbapenem) and less sensitive to other commonly used antibiotics.Conclusions: The main purpose of this study was to find the various common local uropathogens in CKD patients and their antibiotic profile which will help in formulating antibiotic therapies. As previously stated, there are very few studies regarding profile and management of UTI in CKD patients. Hence this study can throw some light into this area.

Evaluation of hepatocellular dysfunction and its association with severity in dengue patients

Background: Dengue is a mosquito-borne infection that in recent years has become an important disease of international public health concern. Dengue virus infections and illness when symptomatic, that patients tend to present with a significantly wide variety manifestations. The aim of the study was to evaluate liver dysfunction in patients with dengue infections.Methods: The present study was undertaken as an observational cross-sectional study the period June 2017 to December 2018. The details of all patients with serologically proved dengue fever admitted in the hospital were reviewed. Data including routine blood count, liver function test (LFT), prothrombin time (PT), activated partial prothrombin time (APTT), abdominal ultrasonography was studied. Statistical analysis: Data was analyzed using SPSS version 21.0. Difference between proportions was tested by using chi square test. Pearson correlation coefficient was used to measure linear correlation between two continuous variables. A p value <0.05 was consideredstatistically significant.Results: Majority of the study participants were in the age group of 16-30 years (57.5%) and were males (64.5%). Fever, Headache and joint pain were the most common symptoms noted among the study participants. Majority of the study participants were found to have elevated levels of SGOT (75.3%), SGPT (64.2%) levels and lower levels ofserum albumin (68.6%) on evaluation. Statistically significant association was observed between elevated liver enzymes and presence of features of dengue haemorrhagic fever.Conclusions: Considerably high proportion of patients with dengue infection were found to have hepatic dysfunction in the form of deranged liver enzymes.

A Case Report Of Shadbindu Taila Nasya And Trikatu Dhoomapana On Apeenasa-atrophic Rhinitis

Acharya Sushruta stated 28 Nasagata rogas. Out of these 28 Nasagata rogas some features of Pootinashya, Dushtha Pratishyaya and Apeenasa are similar to the clinical features of Atrophic Rhinitis (AR). Apeenasa is a Nasagata Roga characterized by nasal obstruction, running nose, Dryness of nose, anosmia, and loss of taste. This condition can be co-related with Atrophic Rhinitis. Though there are many modalities described in modern ENT, still it is not possible to cease the Permanent Impairment. In Ayurved many modalities are being described for Urdhwajatrugata Rogas and for Nasagata Vikara. Among them Nasya (administered of drugs in to nasal cavity) is best. As it is a Kapha Pradhana Vikara, Katu Dhoomapana can also be added to this procedure. The Nashya procedure is explained by Brihatrayees. The complete procedure of Nashya includes Poorva Karma (Snehana and Swedana), mobilizes the Doshas to the site of elimination and causes vasodilatation which helps in elimination of Doshas and provides better channel for absorption of the Oushadhi. Pradhana Karma (Nashya) eliminates the Doshas. Kavala as Paschat Karma eliminates the remaining Doshas and causes better absorption of the Oushadhi which ultimately eliminates the symptoms of the disease. A clinical observation has shown effective result in the treatment of AR with Shadbindu Taila Nasya and Trikatu Dhoomapana. And here we are revalidating the statement of our Acharyas. A case report of a female, aged 38 years with complain of nasal obstruction, foul smell from nose, anosmia, headache, nasal discharge, sneezing and general weakness has been presented here.

Differential Expression of Serum Lysozyme Allelic Variants in Muzaffarnagri Sheep

Lysozyme degrades the bacterial cell walls and gives rise to degradation product that stimulates and activates the immune system. Several gram positive and gram negative bacteria were found to be susceptible to different degree of purified lysozyme. Variation in promoter region may regulate the expression of a particular gene. Hence, considering lysozyme gene a potential marker for general immune response, expression pattern of various genotypes on the basis of variations in promoter region is investigated in Muzaffarnagri sheep. A 268 bp fragment spanning partial promoter, exon 1 and partial intron 1 of serum lysozyme gene were amplified and sequenced. Sequencing revealed five genotypes AA, AB, AC, BB and CC and consequently three alleles A, B and C in Muzaffarnagri sheep. Differential expression study of various genotypes by real time pcr revealed significant difference (P≤0.05) in the serum lysozyme expression in animals having different genotypes. Animals having AA genotype showed higher expression of serum lysozyme than the animals having AB, AC and BB genotype.

Effect of medical and surgical management and dry eyes in Eastern Odisha

Background: Dry eye condition has multi-factorial origin and most of the times missed or left untreated leading to resistance in its treatment modalities. Various studies had been conducted with conflicting outcomes. Dry eyes condition being more prevalent in Odisha, there is very limited published data on its management. Hence this study was conducted to evaluate the efficacy and outcome of medical and surgical management of dry eye cases due to different aetiologies.Methods: Patients were selected from those who attended ophthalmology, Skinand VD, O and G and Paediatrics OPD. Their tear film parameters like Tear film breakup time, tear meniscus height, Schirmer test, Rose Bengal stain were assessed at baseline level. Thereafter they were put on medical therapy for 6 weeks followed by appropriate surgical intervention like amniotic membrane graft, punctual occlusion, use of Symblepharon shell in resistant cases -which again was reviewed by analysis of tear film parameters.Results: Majority of patients (75% approx.) responded well to medical therapy. non responders were due to Steven Johnson syndrome, Vitamin A deficiency, KCS and systemic association. These patients underwent surgical management with follow up after 6 weeks. After 6 weeks of surgical therapy 80% cases showed improvement, while few cases due to SJS showed poor response.Conclusions: The medical modality of treatment was found to be the primary approach with better efficacy in majority of dry eye cases predominantly in mild to moderate severity. Surgical interventions proved more efficacious in severe degree of presentation.

Selective M1 macrophage polarization in granuloma-positive and granuloma-negative Crohn's disease, in comparison to intestinal tuberculosis

BACKGROUND/AIMS: Classical M1 macrophage activation exhibits an inflammatory phenotype while alternative M2 macrophage activation exhibits an anti-inflammatory phenotype. We aimed to determine whether there are discriminant patterns of macrophage polarization in Crohn's disease (CD) and intestinal tuberculosis (iTB). METHODS: Colonic mucosal biopsies from 29 patients with iTB, 50 with CD, and 19 controls were examined. Dual colored immunohistochemistry was performed for iNOS/CD68 (an M1φ marker) and CD163/CD68 (an M2φ marker), and the ratio of M1φ to M2φ was assessed. To establish the innate nature of macrophage polarization, we analyzed the extent of mitochondrial depolarization, a key marker of inflammatory responses, in monocyte-derived macrophages obtained from CD and iTB patients, following interferon-γ treatment. RESULTS: M1φ polarization was more prominent in CD biopsies (P=0.002) than in iTB (P=0.2) and control biopsies. In granuloma-positive biopsies, including those in CD, M1φ predominance was significant (P=0.001). In iTB, the densities of M1φ did not differ between granuloma-positive and granuloma-negative biopsies (P=0.1). Interestingly, higher M1φ polarization in CD biopsies correlated with high inflammatory response exhibited by peripheral blood-derived monocytes from these patients. CONCLUSIONS: Proinflammatory M1φ polarization was more common in colonic mucosa of CD patients, especially in the presence of mucosal granulomas. Further characterization of the innate immune system could help in clarifying the pathology of iTB and CD.

A clinico-radiographic and histomorphometric analysis of alveolar ridge preservation using calcium phosphosilicate, PRF, and collagen plug / 대한악안면성형재건외과학회지

BACKGROUND@#Tooth extraction commonly leads to loss of residual alveolar ridge, thus compromising the room available for the implant placement. To combat the post-extraction alveolar loss, alveolar ridge preservation is practiced, with the advent of the biomaterial available. The purpose of this study was to assess the efficiency of calcium phosphosilicate biomaterial in alveolar ridge preservation. Twenty patients indicated for extraction were selected followed by socket grafting using calcium phosphosilicate. Implant placement was done 6 months postoperatively during which a core was harvested from the preserved sockets. Clinico-radiographic measurements of hard and soft tissues were taken at baseline and 6 months post-grafting.@*RESULTS@#There were no significant changes in the radiographic and soft tissue parameters while significant changes in hard tissue parameters with 1.9 mm (p = 0.013) gain in mid-buccal aspect and 1.1 mm (p = 0.019) loss in horizontal bone width were observed. The histomorphometric evaluation depicted the vital bone volume of 54.5 ± 16.76%, non-mineralized tissue 43.50 ± 15.80%, and residual material 2.00 ± 3.37%.@*CONCLUSION@#The implants placed in these preserved ridges presented 100% success rate with acceptable stability after a 1-year follow-up, concluding calcium phosphosilicate is a predictable biomaterial in alveolar ridge preservation.

Brown-Séquard Syndrome as a First Presentation of Multiple Sclerosis

A female patient aged 48 years presented with sub-acute onset of weakness in right upper and lower limb over the past one month and numbness over left side of body below neck level. Multiple sclerosis (MS) presenting as Brown-Séquard syndrome is very rare. We present a case of hemicord myelitis which presented as Brown-Séquard syndrome as a first manifestation, which was later diagnosed as MS during subsequent relapses.

Chuckling Smile: Ceramic Veneer.

Smiling is not a simple option in those patients who have a severe aesthetic deformity. Many definitions of aesthetics were introduced in dentistry but according to Young, beauty, harmony, naturalness and individuality are the major qualities of aesthetics. The dentist must visualize aesthetics in relation to the patient and then translate that visualization into an acceptable aesthetic result. The success of his efforts depends upon his artistic ability, his powers of observation and experience. Many treatment options are available to achieve aesthetics in compromised anterior teeth but in recent era with the introduction of advanced material (new ceramic and composite materials) has increased the demand of conservative treatment options. Porcelain laminate Veneers (PLVs) were introduced in the 1980s as an alternative to full-coverage crowns. The present case report describes the treatment of fracture & diastema in the anterior dentition with thin ceramic veneers, to restore esthetics and function.

Pattern of use of antibiotics in hospitalized patients in the medicine department of a tertiary care hospital.

Background: (1) To assess pattern of antibiotic use among in-patients of medicine unit in a tertiary care hospital, (2) to determine the frequency of adverse drug reactions (ADR) among the inpatients receiving antibiotics in medicine unit. Methods: The study was prospective and based on the daily review of patient records for 2 months (June, July) of study period, including all the inpatients of medicine unit 1 receiving antimicrobials. The general information of the patients, infection, antimicrobial use, culture and sensitivity reports, concomitant disease, concomitantly administered drugs, as well as clinical response were collected. The prescribed antimicrobials were correlated with the patient’s culture and sensitivity report. The number of defined daily doses (DDDs) administered per patient was calculated for each antimicrobial prescribed as per WHO anatomical therapeutic chemical classification. The ADR observed during the study were assessed using WHO causality analysis. The economic burden of the antimicrobial used was analyzed using average cost of antimicrobial per patient. The study was approved by the Institute Ethics Committee. Results: The antimicrobials that are commonly used as per total drug use (DDDs) are ceftriaxone followed by doxycycline and metronidazole. The antimicrobials account for 58.6% of cost spent on drugs for inpatients. Four antimicrobial related ADR were reported during the study period. Conclusion: Ceftriaxone, doxycycline, and metronidazole are commonly used antibiotics and significant proportion of the cost of drugs is spent for antimicrobials in a medicine unit.

Sirenomelia: Mermaid Syndrome.

A neonate with rare congenital anomalies was born at 25 weeks of gestation and died within 17 minutes of birth. On examination of the baby, it was found that the lower limbs were malrotated and fused all along the length with six toes. External genitalia, urogenital and anal orifices were absent. At autopsy, a single umbilical artery was found arising from the abdominal aorta. Both the kidneys were polycystic and were situated in the iliac fossae. Distal portion of the large gut beyond caecum was absent and rectum was atretic. No reproductive organ was found. On the basis of the findings, the case was diagnosed as sirenomelia (mermaid syndrome).

Split-hand/feet malformation in three tamilian families and review of the reports from India.

Split‑hand/foot malformation (SHFM) is a rare condition which can be either syndromic or nonsyndromic. We report three unrelated pedigrees, one with autosomal dominant (AD) inheritance and the other two with autosomal recessive (AR) pattern. We also briefly review the published reports from India.

Conservative management of horizontal root fractures-case series

Radicular fractures in permanent teeth are uncommon injuries among dental traumas, being only 0.5-7% of the cases. Root fractures occur mainly in the central [68%] and lateral [27%] maxillary incisors; in contrast, only 5% of root fractures are found in mandibular incisors [Caliskan and Pehlivan 1996]. This article presents a case series describing successful conservative management of middle third and incisal third root fractures of the maxillary central incisors