Tongue Disorders Occuring in Diabetes Mellitus Patients – A Prevalence Study

Background: Tongue changes in various systemic diseases have been established in many studies. India being the diabetic capital of the world has many undiagnosed/uncontrolled cases of diabetes.Oral cavity is a mirror of systemic illness; many oral manifestations are associated with the metabolic disease Diabetes mellitus (DM). Aim & Objective: To estimate the prevalence rate of tongue disorders among diabetes mellitus patients. Methods: This observational study includes 100 Diabetic patients taken from the outpatients who reported to the Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College, Chennai and were clinically examined for tongue changes. Results: The prevalence rate of various tongue disorders among the total study population was recorded as 91%. The prevalence of tongue disorders in our study was significantly high in type II DM than type I DM, with respect to specific tongue disorders, a highly significant association was observed between Fissured tongue (17%) and type II DM. Conclusion: Specialists in Oral Medicine & Radiology must look for tongue disorders as one of the oral manifestation of Diabetes mellitus and suspect the presence of DM based on the tongue manifestations in those who are not aware of their Diabetic status and refer them for screening so as to diagnose DM early and treat it effectively.

Comparison of Quality of Life in Oral Cancer Patients following Surgery vs Radiotherapy

Background: Oral cancer being one of the most common malignancies in the low-income group in India. It usually presents in an advanced stage limiting treatment options. The mainstays of treatment being surgery and radiotherapy both being lifestyle changing procedures. Aims and objectives: The purpose of this study is to evaluate the quality of life for oral cancer survivors after surgery in comparison with radiotherapy using ICF questionnaire Materials and methods: Oral cancer patients who underwent surgery (25 patients) and Radiotherapy (25 patients) in Stanley medical college for stage 1 and stage 2 lesions of oral carcinoma for past 3 Years (2013-2015) were enrolled. Results: The study showed that surgery as primary therapy provided a better quality of life than radiotherapy alone in the treatment of oral cancer patients. Conclusion: After comparing the results primary surgery for oral malignancy seems to be the treatment of choice as long as the tumor is amenable to surgical resection. Radiotherapy though resulting in a lower quality of life is very efficacious for unresectable tumors.

Synchronous primary malignancy of head and neck- a case report.

The incidence of multiple primary malignant neoplasms increases with age, reflecting an increase in overall cancer risk in older patients. Cases of two or more concurrent primary cancers are still rare, although its incidence is increasing. Here, we report the case of a 41-years female who was referred to our institution with synchronous papillary carcinoma of thyroid and Adenoid cystic carcinoma of submandibular gland. The case is being presented to emphasize that the clinicians should keep in mind that the appearance of another tumour in a patient suffering from cancer could be either a synchronous or a metachronous or a metastatic lesion.

Cystic lymphangioma of spleen: an abdominal flabbergast.

Lymphangioma is congenital malformation of the lymphatic system. It is usually found in children, occurs mostly in the neck and the mediastinum. It is rarely found in the spleen, mostly asymptomatic or detected incidentally by imaging modalities, however the clinical features of splenic lymphangioma include abdominal pain, nausea, and abdominal distention. In our case report Lymphangioma with cystic component and daughter cysts has radiologists to consider it as other neoplastic diseases of the spleen.

Zero CD4 count: A case of discordant CD4 response in a patient with well suppressed viral load.

Human immunodeficiency virus (HIV) positive patients continue to have raise in CD4 cell for several years after initiation of anti-retroviral therapy (ART). The discordant response of static or fall in CD4 cells in presence of well-suppressed viral load is an unusual finding. In this communication, we present a case report of an HIV patient in whom the repeated CD4 enumerations consistently showed zero/nil CD4 counts before and after the start of ART in spite of maximum viral suppression.

A rapid and low-cost microscopic observation drug susceptibility assay for detecting TB and MDR-TB among individuals infected by HIV in South India.

Background: The converging epidemics of HIV and tuberculosis (TB) pose one of the greatest public health challenges of our time. Rapid diagnosis of TB is essential in view of its infectious nature, high burden of cases, and emergence of drug resistance. Objective: The purpose of this present study was to evaluate the feasibility of implementing the microscopic observation drug susceptibility (MODS) assay, a novel assay for the diagnosis of TB and multi-drug-resistant tuberculosis (MDR-TB) directly from sputum specimens, in the Indian setting. Materials and Methods: This study involved a cross-sectional, blinded assessment of the MODS assay on 1036 suspected cases of pulmonary TB in HIV-positive and HIV-negative patients against the radiometric method, BD-BACTEC TB 460 system. Results: Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the MODS assay in detecting MTB among TB suspected patients were 89.1%, 99.1%, 94.2%, 95.8%, respectively. In addition, in the diagnosis of drug-resistant TB, the MODS assay was 84.2% sensitive for those specimens reporting MDR, 87% sensitivity for those specimens reporting INH mono-resistance, and 100% sensitive for specimens reporting RIF mono-resistance. The median time to detection of TB in the MODS assay versus BACTEC was 9 versus 21 days (P < 0.001). Conclusion: Costing 5 to 10 times lesser than the automated culture methods, the MODS assay has the potential clinical utility as a simple and rapid method. It could be effectively used as an alternative method for diagnosing TB and detection of MDR-TB in a timely and affordable way in resource-limited settings.

Incidence of Haemophilus influenzae type b meningitis in India.

BACKGROUND & OBJECTIVE: Vaccine policy depends on locally relevant disease burden estimates. The incidence of Haemophilus influenzae type b (Hib) disease is not well characterized in the South Asian region, home to 30 per cent of the world's children. There are limited data from prospective population incidence studies of Hib in Asia, and no data available from India. We therefore carried out this study to assess the burden of Hib meningitis in India. METHODS: A prospective surveillance study was carried out during 1997 and 1999 in hospitals for cases of Hib meningitis from 5 administrative areas of an Indian district (Vellore, Tamil Nadu) with 56,153 children under 5 yr of age, over a 24 month period RESULTS: Ninety seven cases of possible meningitis (> 10 WBC/microl in CSF) were reported, an annual incidence of 86 per 100,000 (95%CI 69 to 109) in 0-4 yr old children, and 357 per 100,000 in 0-11 month infants. Eighteen had proven bacterial meningitis, an annual incidence of 15.9 per 100,000. Eight CSF had Hib by culture or antigen testing, an annual incidence of 7.1 per 100,000 (95%CI 3.1 to 14.0) in children 0-59 months. In infants 0-11 months of age, the incidence of Hib meningitis was 32 per 100,000 (95%CI 16 to 67) and in the 0-23 month group it was 19 (95%CI 8 to 37). INTERPRETATION & CONCLUSION: Our data are the first minimal estimate of the incidence of Hib meningitis for Indian children. The observed incidence data are similar to European reports before Hib vaccine use, suggest substantial disease before 24 months of age, and provide data useful for policy regarding Hib immunization.

Cutaneous cryptococcosis among HIV infected patients.

Five patients with HIV associated cutaneous cryptococcal infection are reported.

Cryptococcal meningitis among HIV infected patients.

Cryptococcal meningitis is an emerging opportunistic infection among HIV infected patients and an important cause of mortality among these patients. The incidence of cryptococcal meningitis varies from place to place. A total of 31 specimens of CSF out of 89 samples processed from known HIV positive cases yielded Cryptococcus neoformans during the period of 3 years. C.neoformans was the most common opportunistic pathogen isolated from CSF samples of these patients with an incidence of 34.8%

Omental plug closure of large duodenal defects--an experimental study.

This study was conducted to evaluate the efficacy of omental plugging in the management of large duodenal defects and analyse the serial histopathological changes occurring in the omental plug and the edges of the defect until healing occurred as evidenced by complete mucosal cover. The study was conducted in 12 dogs. Through a laparotomy wound a 20 mm diameter defect was created in the first part of the duodenum. The abdomen was closed, leaving the defect open, for a period of three hours to allow peritonitis to set in. Subsequently the abdomen was reopened and the perforation was plugged with omentum pulled into the duodenal lumen and fixed to the edges. They were randomly sacrificed two at a time on the first week, second week, fourth week, sixth week and eight week post operatively. The morphology of the perforation site, adequacy of the duodenal lumen, and the histological picture at each stage were studied. There was no morbidity except in one dog which showed signs of high intestinal obstruction that resolved after conservative management. There was one mortality due to sepsis unrelated to the procedure. The omentum was firmly adherent and there was no evidence of leak from the site of closure. The omental plug underwent inflammation, necrotic changes, granulation, reduction in size and fibrosis. The defects decreased rapidly in size and healing was complete at eight weeks with the mucosa taking a normal histological appearance. None of the dogs exhibited luminal obstruction on autopsy. This study reaffirms the reliability of the omental plug in safely occluding large duodenal defects and producing healing through a process of inflammation, granulation, vascularisation and fibrosis eventually providing a normal duodenal mucosal cover to the perforation site.

An unusual cause of small bowel obstruction. A case report.

A patient presented with recurrent episodes of colicky abdominal pain, nausea and vomiting, precise cause of which could not be established on evaluation. Exploratory laparotomy revealed internal herniation of proximal small bowel loops into the mesentericoparietal fossa of Waldeyer. There was a successful surgical outcome.