Macro and microscopic study of a rare case of Papilliferous Keratoameloblastoma using a stereo zoom microscope

Papilliferous keratoameloblastoma is an extremely rare variant of ameloblastoma, a benign odontogenic tumor, with only seven cases reported in the English language literature. This variant presents with the metaplastic transformation of stellate reticulum-like cells to the extent of forming papillary structures exhibiting superficial keratinization of varying thickness. This paper describes the pathognomonic macroscopic features of this tumor observed during gross examination under the stereo zoom microscope that differentiate it from the other odontogenic tumors which have not been explored in the previously documented cases. Also, in this paper, a detailed comparison of the macroscopic features observed under the stereo zoom microscope during gross examination with the microscopic features of the histologic section has been described proving to be useful in the histological differential diagnosis of the keratinizing variants of ameloblastoma.

The rates of visual field progression in glaucoma and its clinical importance / Taxas de progressão do campo visual em glaucoma e sua importância clínica

ABSTRACT The rate of visual field progression is an essential factor in determining risk of visual disability or blindness in glaucoma patients. Knowledge of the rate of progression of a particular patient, in combination with an estimation of their longevity and other clinical factors, allows clinicians to optimize management by providing appropriately aggressive treatment. Despite decades of research on the treatment of glaucoma, the natural history of glaucomatous visual field progression in untreated and treated patients remains unclear. The purpose of this review is to provide a comprehensive summary of the literature surrounding the rate of visual field progression in glaucoma. Most of the available data pertains to primary open angle glaucoma, but we will also review progression rates in other subtypes of open angle glaucoma, such as pseudoexfoliative glaucoma and normal tension glaucoma, as well as in primary angle closure glaucoma. Specifically, we will cover methods to identify rates of progression, rates of progression in treated versus untreated patients, factors that may influence progression, and lastly, suggest some parameters that might help clinicians in determining acceptable rates of visual field deterioration in patients with glaucoma.

RESUMO A taxa de progressão do campo visual é um fator essencial para determinar o risco de incapacidade visual ou cegueira em pacientes com glaucoma. Conhecer a taxa de progressão de um determinado paciente, em combinação com uma estimativa de sua longevidade e outros fatores clínicos, permite que os médicos otimizem a conduta, fornecendo um tratamento adequadamente agressivo. Apesar de décadas de pesquisa sobre o tratamento do glaucoma, a história natural da progressão do campo visual glaucomatoso em pacientes não tratados e tratados permanece pouco clara. O objetivo desta revisão é fornecer um resumo abrangente da literatura sobre a taxa de progressão do campo visual do glaucoma. A maioria dos dados disponíveis diz respeito ao glaucoma de ângulo aberto primário, mas também revisaremos as taxas de progressão em outros subtipos de glaucoma de ângulo aberto, como o glaucoma pseudoexfoliativo e o glaucoma de tensão normal, bem como o glaucoma primário de ângulo fechado. Especificamente, iremos cobrir métodos para identificar taxas de progressão, taxas de progressão em pacientes tratados versus não tratados, fatores que podem influenciar a progressão e, finalmente, sugerir alguns parâmetros que podem ajudar os médicos a determinar taxas aceitáveis de deterioração do campo visual em pacientes com glaucoma

An unusual case of unresolving tunnel infection in a patient on continuous ambulatory peritoneal dialysis

Atypical mycobacteria remain a rare cause of peritoneal dialysis catheter-related tunnel infection (TI) and poses serious risk because of the resistant nature to most antibiotic therapy. Non-tubercular mycobacterial infections lead to chronicity requiring peritoneal dialysis catheter removal. We report an 82-year-old male, with diabetic nephropathy who had a coinfection with Staphylococcus hominis and Mycobacterium abscessus who presented with pus discharge at exit site and TI. He was treated with relocation of the extraperitoneal part of the catheter with a new exit site without catheter removal and multidrug mycobacterial therapy.

Twenty-one episodes of peritonitis in a continuous ambulatory peritoneal dialysis patient: What is the root cause?

A 51-year-old female, with non-alcoholic liver cirrhosis, portal hypertension, type 2 diabetes mellitus, autosomal dominant polycystic kidney disease with a clipped cerebral aneurysm and chronic kidney disease stage 5 was on continuous ambulatory peritoneal dialysis (CAPD) for 6.5 years elsewhere. She came for opinion on continuation of CAPD as she had 21 episodes of peritonitis in 76 months. Her blood pressure was 80/50 mmHg. She was on haemodialysis with a temporary central access for 2 weeks. She had no abdominal tenderness, and exit site looked normal. Fluid was negative for Mycobacterium tuberculosis. Laparoscopically, we replaced the catheter with a new swan-neck Tenckhoff double-cuff catheter through a different exit site in the same sitting. Catheter-tip biofilm culture isolated Enterococcus casseliflavus. Peritoneal sampling biopsy showed evidence of fibrosis. She has adequate ultrafiltration and is currently on automated peritoneal dialysis for 5 months.

Oral Health Status of Institutionalized Leprosy Patients in Kerala

This study has been undertaken to evaluate the oral health status of treated institutionalised leprosy patients in Kerala. A cross sectional descriptive study was conducted in 750 institutionalized treated leprosy patients residing in 6 different leprosy care centres (three government sanatoria and three non governmental leprosy institutions) in Kerala. Treated leprosy afflicted persons (LAPs) who provided consent to participate in the study were included. The oral health status was assessed by clinical examination and findings were recorded using WHO Oral Health Assessment Form (1997). Among 750 leprosy patients examined, 393 were males and 357 were females. The prevalence of oral mucosal lesions was 57 (7.6%). Oral Candidiasis 18 (2.4%) was the most prevalent oral mucosal lesion followed by palatal ulceration 12(1.6%). The proportion of persons having extra oral lesions was 531(70.8%). Temporo-mandibular-joint (TMJ) disorders were present in 352 (47%) subjects. Periodontal status of the subjects were poor, 570 (76.8%) subjects were having calculus or pockets. Majority of the subjects 411(54.8%) had periodontal pocket of 4mm or more. 581 (76.8%) subjects had attachment loss. These subjects had a prevalence of 459 (61.2%) for dental caries. The treatment needs of the population were high, i.e. 73.6% needed filling, 70.4% required extraction, 92.6% required prostheses and 0.8% required crown. Dental caries, periodontal disease, oral mucosal lesions, and TMJ problems were prevalent in these institutionalized leprosy patients. After the comparison with National Oral Health data, it was observed that only the missing teeth and DMFT were higher in this institutionalized population of leprosy afflicted persons (LAPs), otherwise oral health conditions as such are not good in this age groups in general population as well as LAPs. The prosthetic needs of this community appear to be largely unmet, which requires timely intervention. Oral health problems of such leprosy afflicted persons, already treated for leprosy but living in institutions due to social reasons, can be minimised by appropriate interventions such as oral health education and oral health care programmes organized on a regular basis.

Management of Children with Severe Acute Malnutrition: Experience of Nutrition Rehabilitation Centers in Uttar Pradesh, India.

Objective: To assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in Nutrition Rehabilitation Centers (NRC). Design: Review of data. Setting: 12 NRCs in Uttar Pradesh, India. Participants: Children admitted to NRCs (Jan 1, 2010 - Dec 31, 2011). Intervention: Detection and treatment of SAM with locallyadapted protocols. Outcomes: Survival, default, discharge, and recovery rates. Results: 54.6% of the total 1,229 children admitted were boys, 81.6% were in the age group 6-23 months old, 86% belonged to scheduled tribes, scheduled castes, or other backward castes, and 42% had edema or medical complications. Of the 1,181 program exits, 14 (1.2%) children died, 657 (47.2%) children defaulted, and 610 (51.7%) children were discharged The average (SD) weight gain was 12.1 (7.3) g/kg body weight/day and the average (SD) length of stay was 13.2 (5.6) days. 206 (46.8%) children were discharged after recovery (weight gain ≥15%) while 324 (53.2%) were discharged, non-recovered (weight gain <15%) Conclusions: NRCs provide life-saving care for children with SAM; however, the protocols and therapeutic foods currently used need to be improved to ensure the full recovery of all children admitted.

Selective surgical management of penetrating anterior abdominal wounds at the Angau Memorial Hospital: a prospective study

Trauma is a leading cause of admissions to the surgical ward in Papua New Guinea (PNG), accounting for about 35% of cases. Of these, 15% of cases are abdominal injuries, of which 19% are penetrating injuries. Selective surgical management of patients with a low-velocity anterior abdominal wound (AAW) is beneficial in some patients. AIM: To determine if selective surgical management is a viable therapeutic option in PNG. METHODS: A non-random prospective study of consecutive cases was done on 60 patients with an AAW based entirely on clinical symptoms and signs. The outcome measures were length of hospital stay, morbidity and mortality. Data were analysed using SPSS 10.0 for Windows and Microsoft Excel. RESULTS: Immediate laparotomy was done on 24 (40%) of cases and 36 (60%) had nonoperative conservative management, of which 6 (17%) failed and went on to have laparotomy on demand. The average hospital stay was 4 days shorter (p = 0.0001) for the nonoperative group, which had significantly fewer complications (p = 0.01). No deaths were recorded in either of the two groups of patients. CONCLUSION: Selective nonoperative management of stable patients with an AAW with or without omental signs is a safe therapeutic option in PNG.

In vitro studies of multiwalled carbon nanotube/ultrahigh molecular weight polyethylene nanocomposites with osteoblast-like MG63 cells

Carbon nanotubes are highly versatile materials; new applications using them are continuously being developed. Special attention is being dedicated to the possible use of multiwalled carbon nanotubes in biomaterials contacting with bone. However, carbon nanotubes are also controversial in regards to effects exerted on living organisms. Carbon nanotubes can be used to improve the tribological properties of polymer/composite materials. Ultrahigh molecular weight polyethylene (UHMWPE) is a polymer widely used in orthopedic applications that imply wear and particle generation. We describe here the response of human osteoblast-like MG63 cells after 6 days of culture in contact with artificially generated particles from both UHMWPE polymer and multiwalled carbon nanotubes (MWCNT)/UHMWPE nanocomposites. This novel composite has superior wear behavior, having thus the potential to reduce the number of revision hip arthroplasty surgeries required by wear failure of acetabular cups and diminish particle-induced osteolysis. The results of an in vitro study of viability and proliferation and interleukin-6 (IL-6) production suggest good cytocompatibility, similar to that of conventional UHMWPE (WST-1 assay results are reported as percentage of control ± SD: UHMWPE = 96.19 ± 7.92, MWCNT/UHMWPE = 97.92 ± 8.29 percent; total protein: control = 139.73 ± 10.78, UHMWPE = 137.07 ± 6.17, MWCNT/UHMWPE = 163.29 ± 11.81 µg/mL; IL-6: control = 90.93 ± 10.30, UHMWPE = 92.52 ± 11.02, MWCNT/UHMWPE = 108.99 ± 9.90 pg/mL). Standard cell culture conditions were considered as control. These results, especially the absence of significant elevation in the osteolysis inductor IL-6 values, reinforce the potential of this superior wear-resistant composite for future orthopedic applications, when compared to traditional UHMWPE.

Camptodactyly in Sotos syndrome.

We describe a girl with Sotos syndrome presenting at two and a half years age with developmental delay. She has camptodactyly which has not previously been reported in Sotos syndrome but is a common finding in Weaver syndrome. Both these conditions have been reported to have NSD1 gene mutations. This report is consistent with the conditions being allelic.

Rhinoentomophthoromycosis.

A sixty year old patient presented with a slowly progressive swelling of the nose, of one year duration, suggesting a clinical diagnosis of subcutaneous zygomycosis. On investigation, the tissue fungal culture grew Conidiobolus coronatus, confirming the diagnosis as rhinoentomophthoromycosis. He was treated with a combination of oral fluconazole and oral potassium iodide for a total period of 5 months. His symptoms subsided completely. Serial CT scanning of paranasal sinuses showed the gradual resolution of the swelling, in response to the treatment. Early detection of the disease and combination therapy gave rapid and good results. This is the first case of its kind to be reported from Kerala, the southern state of India.

A novel Kv1.1 potassium channel blocking toxin from the venom of Palamneus gravimanus (Indian black scorpion)

A peptide toxin was isolated from the venom of Palamneus gravimanus, the Indian black scorpion, to block human Kv1.1 channels expressed in Xenopus laevis oocytes. A 4.5 kD peptide (toxin), as confirmed by SDS-PAGE, was purified to homogeneity by ion exchange chromatography using CM-Sephadex C-25 followed by Sephadex G-50 gel filtration. Palamneus gravimanus toxin (PGT) selectively blocks the human cloned voltage-gated potassium channel hKv1.1 in a two-electrode voltage-clamp (TEVC) technique. The results obtained indicate that the toxin blocks the hKv1.1 channel at a nanomolar concentration range (Ki value of 10 nM) of the peptide to the external side of the cell. The blockage seems to be voltage-dependent. Comparative structure of PGT (a 4.5 kD peptide) with BTK-2 suggests a close relationship; therefore this toxin can be employed to investigate the hKv1.1 channel structure.

Diagnostic dilemma in coinfection.

A Fifteen years girl belonging to a low socioeconomic status was admitted with peritonsillar abscess caused by methicillin resistant Staphylococcus aureus (MRSA), high fever, diarrhoea and septicaemic shock. Initial blood cultures and widal test, stool cultures and routine stool examination were non-contributory to the diagnosis. A bone marrow culture in the second week confirmed the diagnosis of Salmonella typhi infection. Examination of a fresh stool sample showed cysts of Entamoeba histolytica. She was treated with ciprofloxacin, metronidazole, augmentin and ceftriaxone. She had no clinical evidence of immunosuppression prior to this episode and her HIV test was negative. This case report highlights the presence of community acquired MRSA infection causing perititonsillar abscess, and the diagnostic dilemma of fever and diarrhoea due to coinfection with Salmonella typhi and Entamobea histolytica.

Gelatinous transformation of bone marrow following chemotherapy for myeloma.

Gelatinous transformation of the marrow (GTBM) has been associated with various conditions. We present a unique case of GTBM in a patient with myeloma following treatment with Melphalan.

Central nervous system toxoplasmosis in acquired immunodeficiency syndrome: An emerging disease in India.

With the incidence of patients infected with human immuno-deficiency virus (HIV) increasing in India, the central nervous system (CNS) manifestations of the disease will be seen more frequently. The CNS may be primarily afflicted by the virus or by opportunistic infections and neoplasms secondary to the immune suppression caused by the virus. In India, although mycobacterium tuberculosis has been reported to be the most common opportunistic infection, toxoplasmosis may become as common owing to the ubiquitous nature of the protozoan. Since an empirical trial of medical therapy without histopathological diagnosis is recommended, the true incidence of this condition may remain under estimated. The role of ancillary tests such as radiology and serology in the initial diagnosis of this condition remain crucial. This report highlights two patients who were diagnosed to have acquired immuno-deficiency syndrome (AIDS) only after the biopsy of the intracranial lesion was reported as toxoplasmosis. Presently all patients for elective neurosurgery are tested for HIV antigen. The management protocol to be followed in a known patient with AIDS presenting with CNS symptoms is discussed in detail. The value of ancillary tests is also reviewed.

Shigella and the fluorinated quinolones.

Between July 1996 to June 1997 a total of 531 Stool samples from cases of acute diarrhoea, dysentry, colitis admitted to Kasturba Medical College Hospital, Manipal were investigated. Shigella were isolated from 29 samples (5.46%). Out of them, Shigella flexneri were 16 (55.17%), Shigella boydii 8 (27.58%), Shigella dysentriae 3 (10.34%) and Shigella sonnei 2 (6.89%). Five strains of Shigella flexneri and one strain of Shigella dysentriae were found to show resistance to Nalidixic acid and the newer fluoroquinolones viz., Ciprofloxacin, Norfloxacin and Ofloxacin. The in vitro 'R' factor transfer study showed that the resistance was not transferable.

Facile formation of heteromultimeric potassium channels by expression of cloned human cDNAs.

Complementary DNAs representing three voltage-gated potassium channels of human origin have previously been expressed in Xenopus laevis oocytes by injecting RNA transcribed in vitro [Ramaswami, M., Gautam, M., Kamb, A., Rudy, B., Tanouye, M. A. & Mathew, M. K. (1990) Mol. Cell. Nueorsci 1, 214-223]. We have coinjected RNAs for pairs of K(+)-channel genes into Xenopus oocytes. Analysis of the kinetics of the evoked currents, their voltage dependence and pharmacological sensitivities demonstrate that channels formed on coinjection of RNA pairs have properties distinct from those evoked by either channel type alone. We conclude that these currents arise from heteromultimeric aggregates of the subunits encoded by the individual RNAs. Quantitative analysis of the currents indicate that at least 60% of the current seen can be ascribed to heteromultimeric channels demonstrating their facile formation. Given that there are a large number of primary transcripts present in the nervous system, the demonstration of pharmacologically distinct heteromultimers may complicate the extension of studies on single, cloned K(+)-channels in heterologous systems to neuronal cells.