Plasma Cell Gingivitis: Clinical and Pathological Case Report.

INTRODUCTION: Plasma cell gingivitis (PCG) is a rare benign condition usually found on marginal and attached gingiva. This case details a generalized PCG, to include the management of the patient and clinicopathologic characteristics of the disorder. CASE PRESENTATION: The patient, a 24-year-old African American female, was referred to the periodontics clinic for severe generalized gingival erythema and edema. Past medical history review was remarkable for sickle cell anemia and systemic lupus erythematosus. The patient was initially prescribed dexamethasone oral rinse (0.5 mg/5 ml) pending biopsy and medical consult for potential causes of any hypersensitivity reaction. The patient also was instructed to discontinue her current type of oral mouthrinse and dentifrice. Biopsy results confirmed a diagnosis of PCG. Resolution of signs and symptoms started 1 month later, and approximately 2 years after initial diagnosis the patient was clinically stable. CONCLUSION: This report describes the management of a diffuse plasma cell gingivitis and reviews pertinent literature on the lesion. The etiology of PCG, although unclear, may be attributable to a hypersensitivity reaction. PCG may mimic other pathological entities, which underscores the importance of microscopic examination in establishing a definitive diagnosis before treatment initiation.

Two-step pull-through colo-anal anastomosis aiming to avoid stoma in rectal cancer surgery: A "real life" study in a developing country.

BACKGROUND: Delayed colo-anal anastomosis (DCA) is an underused technique rarely performed after resection of primary low rectal adenocarcinoma. The objective of this study was to compare the short-term outcomes of DCA and classical colo-anal anastomosis (CAA). METHODS: This is a retrospective comparative study carried out at two tertiary centres in Morocco and France. It included all patients who underwent colo-anal anastomosis after complete mesorectal excision for primary rectal adenocarcinoma between January 2018 and December 2019. The main outcomes were 90-day morbidity and rates completing the surgical steps of DCA and CAA. RESULTS: Among 215 rectal resections, 45 patients received colo-anal anastomosis, including 19 DCA and 26 CAA. Seventeen patients in the DCA group completed the two steps compared to 16 in the CAA group (89.5% vs. 61.5%, P=0.04). The rates of severe complications (26.9% vs. 26.3%, P=0.96) and anastomotic leakage (42.3% vs. 31.6%, P=0.46) were not different between the two groups. CONCLUSION: This study showed that DCA was associated with a higher rate of completing the two surgical steps, with no difference in overall and severe morbidity. DCA may be a strong alternative to classical colo-anal anastomosis.

Bacterial Invasion of Pulp Blood Vessels in Teeth with Symptomatic Irreversible Pulpitis.

INTRODUCTION: This study described the degenerative changes and infection patterns of the pulp tissue associated with symptomatic irreversible pulpitis. METHODS: The material consisted of 32 extracted teeth with untreated deep caries that were clinically and histologically diagnosed with irreversible pulpitis and were part of the histopathologic collection of 1 of the authors. The controls consisted of intact teeth with normal uninflamed pulps and teeth with reversible pulpitis. Teeth were processed for histopathologic and histobacteriologic analyses. RESULTS: All teeth with irreversible pulpitis showed areas of severe acute inflammation, necrosis, microabscesses, and bacterial infection in the pulp chamber. These areas were surrounded by a chronic inflammatory infiltrate, and, at the distance, the pulp tissue was often uninflamed. Bacteria were also observed in the areas surrounding the necrotic foci, both as scattered cells through the extravascular space and at varying numbers within the blood vessel lumen. The number of bacteria and the density of the intravascular bacterial aggregations varied considerably. In one third of the cases, bacteria occurred in the lumen of venules in areas at a considerable distance from the necrotic focus in the coronal third of the root. No intravascular bacteria were noted in the middle and apical segments of the canal. No bacteria were found in the pulps of any of the control specimens. CONCLUSIONS: Bacterial invasion and colonization of necrotic areas were observed in the pulp of all teeth with caries exposure and symptomatic irreversible pulpitis. Bacterial penetration of blood vessels occurred in all cases, suggesting that this may be an important mechanism of spread of bacterial infection through the pulp tissue in an endodontic infection.

A Locally Aggressive Ameloblastic Fibro-Odontoma: A Case Report and Literature Review.

Ameloblastic fibro-odontoma (AFO) is a relatively rare, benign noninvasive mixed odontogenic neoplasm derived from epithelial and ectomesenchymal elements of the dental tissues. It usually presents with a mean age of 11.5 years and in the posterior segment of the mandible. It is extremely rare in the posterior maxilla. Although the latest WHO edition classified AFO as developing odontoma, here we present a locally aggressive AFO in a 21-year-old male involving the posterior maxilla and sinus with bone destruction. The patient presents with a two-year history of slowly progressive left facial swelling with malodorous drainage. The CT scan revealed a 5.5 x 4.3 cm well-circumscribed expansile mass with mixed attenuation and peripheral calcification occupying the left maxilla and sinus with bone destruction of the hard palate and orbital rim. According to the literature, most of the AFO cases were treated adequately through a conservative approach with just enucleation or surgical curettage. To our knowledge, our case is the first case treated aggressively with left maxillectomy, palatectomy, and reconstruction surgery because of its radiologic findings, which suggested a locally invasive neoplasm. Histologically, the specimen showed a mixture of proliferative epithelial, mesenchymal tissue elements, and variable amounts of mineralized deposits consisting of enamel matrix and dentinoid deposits, and the final diagnosis was AFO. In conclusion, we present a rare case of AFO with an unusual aggressive presentation, age group, and site involved. The radiographic, histopathologic features, and therapeutic approaches of this unusual locally aggressive tumor are presented with the review of relevant literature.

A dual role of 12/15-lipoxygenase in LPS-induced acute renal inflammation and injury.

Recent studies suggest a potential role of bioactive lipids in acute kidney injury induced by lipopolysaccharide (LPS). The current study was designed to determine the profiling activities of various polyunsaturated fatty acid (PUFA) metabolizing enzymes, including lipoxygenases (LO), cyclooxygenase, and cytochrome P450 in the plasma of LPS-injected mice using LC-MS. Heat map analysis revealed that out of 126 bioactive lipids screened, only the 12/15-LO metabolite, 12-HETE, had a significant (2.24 ±â€¯0.4) fold increase relative to control (P = 0.0001) after Bonferroni Correction (BCF α = 0.003). We then determined the role of the 12/15-LO in LPS-induced acute kidney injury using genetic and pharmacological approaches. Treatment of LPS injected mice with the 12/15-LO inhibitor, baicalein, significantly reduced levels of renal injury and inflammation markers including urinary thiobarbituric acid reactive substance (TBARs), urinary monocyte chemoattractant protein-1 (MCP-1), renal interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Similarly, knocking-out of 12/15-LO reduced levels of renal inflammation and injury markers elicited by LPS injection. Next, we tested whether exogenous supplementation with docosahexaenoic acid (DHA) as a substrate would divert the role of 12/15-LO from being pro-inflammatory to anti-inflammatory via increased production of the anti-inflammatory metabolite. DHA treatment restored the decreased in plasma level of resolvin D2 (RvD2) and reduced renal injury in LPS-injected mice whereas DHA treatment failed to provide any synergistic effects in reducing renal injury in LPS injected 12/15-LO knock-out mice. The ability of RvD2 to protect kidney against LPS-induced renal injury was further confirmed by exogenous RvD2 which significantly reduced the elevation in renal injury in LPS injected mice. These data suggest a double-edged sword role of 12/15-LO in LPS-induced acute renal inflammation and injury, depending on the type of substrate available for its activity.

Multiple Endocrine Neoplasia Type 2b (MEN2B) in a 9-Year-Old Female.

Multiple endocrine neoplasia (MEN) is an uncommon genetic syndrome transmitted as an autosomal dominant condition characterized by multiple tumors or hyperplasia of neuroendocrine tissues. MEN type 2b (MEN2B) often has clinical signs of marfanoid facial appearance and mucosal neuromas of the head. This report describes the diagnosis of MEN2B in a previously undiagnosed 9 year old who presented for biopsy of an oral lesion.

Epidemiology of nosocomial fungal infections in the National Center for Burns in Casablanca, Morocco.

Fungal infection is a leading cause of death in burns patients and incurs significant costs for burn units. Our aim was to determine epidemiology of these infections, and analyze risk factors in the burns intensive care unit of the National Center for Burns and Plastic Surgery at Ibn-Rochd University Hospital, Casablanca. It is a retrospective review of all patients admitted from 2011-2014 who developed cultures positive for fungal organisms. Criteria for nosocomial fungal infections were those of the Center for Disease Control in Atlanta (1988, revised 1992, 2004). Microbiological surveillance was carried out daily. Patient demographic data, % TBSA, type of infection, site(s), species and number of cultures, and risk factors for fungal infections were collected. Mean age of patients was 24.5 +/- 27.3 years; 63% were female. Mean % TBSA was 30.7 +/- 23.4%, and % FTSA was 21.7 +/- 20.1%. Injury due to flame was most common (82%), followed by scald (10%), contact (4%), electrical (3%) and chemical (1%). Incidence of nosocomial fungal infection was 10%. The fungal pathogen most frequently isolated was Candida albicans (65.7%), followed by other Candida species (18.6%). Aspergillus spp was present in 3.9% and was statistically associated with mortality (3.2%) and morbidity. In our study, risk factors for these infections were mostly degree of burn (mean TBSA = 30.7%) and prolonged broad-spectrum antibiotic therapy. These two factors were associated with a higher incidence of multiple positive cultures, and significantly increased mortality (21.6%). Amphotericin B and fluconazole were the most frequently used antifungal agents. Fungi are emerging as important nosocomial pathogens. The main clinical implications are thinking faster about fungi infections and being more careful with antibiotic prescriptions.

Les infections fongiques sont une cause majeure de mortalité chez les brûlés et en augmente significativement le coût de prise en charge. Cette étude a pour buts de déterminer l'épidémiologie et d'analyser les facteurs de risque de leur survenue dans le centre national des brûlés de l'hôpital Ibn-Roch de Casablanca. Il s'agit d'une revue rétrospective des patients hospitalisés entre 2011 et 2014 ayant eu des cultures fongiques positives. Les critères de définition d'une infection fongique nosocomiale (IFN) étaient ceux du CDC d'Atlanta de 1988, révisés en 1992 et 2004. La surveillance microbiologique était journalière. Les données démographiques, la surface atteinte, le type et le (les) sites de l'infection, l'espèce, le nombre de cultures positives on été colligés. Les facteurs de risque de survenue d'une IFN ont été analysés. L'âge était de 25,4 +/- 27,3 ans, 63% des patients étaient des femmes. La surface brûlée était de 30,7 +/- 23,4% dont 21,7 +/- 20,1% profond. Les brûlures par flammes étaient les plus fréquentes (82%), suivies des ébouillantements et des brûlures par contact. L'incidence des IFN était de 10%. Candida albicans y était l'espèce la plus largement représentée (65,7%), suivie par 18,6% de « Candida non albicans ¼. Aspergillus spp étaient retrouvés dans 3,9% des cas et clairement associés à la mortalité et la morbidité. Les facteurs de risque étaient essentiellement la surface brûlée et l'antibiothérapie à large spectre prolongée. Ils étaient associés à un plus grand nombre de cultures positives multiples et à une surmortalité (21,6%). L'amphotéricine B et le fluconazole étaient les antifongiques les plus prescrits. Les champignons devenant des agents fréquents d'infections nosocomiales, il est nécessaire d'y songer rapidement et de limiter les prescriptions d'antibiotiques.

The use of a thermal camera and Eulerian enhancement in the examination of pedal pulse and microvascular health.

Early detection of impaired blood flow and microvascular functioning is important to prevent ulceration in diabetic patients. This paper aims to first determine if thermal video in conjunction with Eulerian Video Magnification (EVM) can be used to find the pedal pulse rate, and reveal patterns indicative of the foot's microvascular health. Thermal video was captured of a healthy adult's foot while a Doppler ultrasound captured pedal pulse. Another thermal video was captured of a patient's heels. These videos were subjected to EVM, areas of interest were defined and the mean intensity signal was calculated temporally, within each defined area. The healthy adult signals were compared to Doppler data to determine the signal best representative of pedal pulse. The patient signals were examined for patterns. The mean intensity signals best representing pedal pulse in the healthy adult resulted from areas containing an artery close to the skin. The most significant pattern in the patient data was a large difference in signal amplitude from areas containing the left posterior tibial artery and the right; the left, colder heel had a weaker signal amplitude. These results suggest that thermal video subjected to EVM can reveal the pedal pulse rate by extracting intensity signals from areas in which arteries are close to the skin, and may reveal differences in the microvascular health of the left versus right foot. The ability to detect pedal pulse and differences in microvascular health using an inexpensive and non-intrusive thermal camera would of great value to a podiatric clinic.

Lingual Gingival Cyst of the Adult.

INTRODUCTION: Gingival cysts of the adult (GCAs) are rare developmental soft tissue cysts usually found on the facial attached gingiva. Documented cases on the lingual aspect are extremely uncommon. This report details a lingual GCA along with distinguishing characteristics of this lesion. CASE PRESENTATION: The patient, a 37-year-old female, presented with a firm, round-shaped, bluish swelling on the lingual gingiva in the interproximal area between teeth #21 and #22. Radiographs revealed a circular radiolucency at the osseous crest. Surgical exploration showed cystic-appearing tissue with accompanying bone resorption. Histologic examination, along with clinical presentation, confirmed a diagnosis of gingival cyst. Healing was uneventful with no evidence of recurrence at a 5-month recall. CONCLUSIONS: A GCA is usually of odontogenic origin and occurs typically in the attached gingiva of the mandibular premolar region. Occasionally, it demonstrates radiographic evidence of bone loss from pressure resorption. Its more frequent intraosseous counterpart, the lateral periodontal cyst, shares histopathologic characteristics with the GCA. These findings underscore the importance in establishing a definitive diagnosis.

Épidémiologie des brûlures de la main chez les enfants vus dans le Centre National des Brûlés et de Chirurgie Plastique de Casablanca, Maroc.

Hand burns in children are common and may lead to debilitating sequelae. Therefore, full functional restoration of the hand is the goal of treatment. To assess the epidemiological, clinical and development aspects of the burns, we conducted a retrospective study over 4 years, from January 2011 to January 2015. It evaluated 313 children suffering from burns and treated at the National Burn and Plastic Surgery Unit of Ibn Richd Teaching Hospital in Casablanca. Most patients were aged 3-6 years (70%), with a slight male predominance. Scalds accounted for 62% of the causes of burns, flames 33% and electricity 4.5%. Chemical and contact-related burns were anecdotal (1 case of each). Seventy-two per cent of the patients had partial thickness burns, which healed spontaneously. Awareness of and education on these accidents should be part of the school curriculum in order to reduce the incidence of burns in childhood.

Retrospective study on idiopathic bone cavity and its association with cementoosseous dysplasia.

OBJECTIVE: The goal of this study was to reveal clinical and pathologic findings on idiopathic bone cavity lesions (IBC). STUDY DESIGN: A retrospective analysis of 20 IBC cases diagnosed from 2004 to 2014 from a university-based maxillofacial pathology service was performed and included all pertinent clinical, histologic, and radiographic findings. RESULTS: Eleven women (age = 36 ± 12.7) and 9 men (age = 23 ± 17.9) diagnosed with IBC were selected for analysis. There was a higher African-American female predilection (40%). Thirty percent of the cases were associated with florid cementoosseous dysplasia (COD) (all middle-aged African-American women). The location of the lesions was mandibular in 85% of the patients. All symptomatic patients (25%) had concomitant COD. Only 1 patient reported previous trauma, and only 1 patient had prior orthodontic treatment. Follow-up period ranged from 1 to 8 years, with only 1 recurrence 3 years after surgery. CONCLUSIONS: The results suggest that IBC concurrent with COD may not be as rare as the literature implies. Clinicians must be attentive to this possible relationship to ensure accurate diagnosis and appropriate treatment.

Using integrated bio-physiotherapy informatics in home health-care settings: A qualitative analysis of a point-of-care decision support system.

The growing need to gain efficiencies within a home care setting has prompted home care practitioners to focus on health informatics to address the needs of an aging clientele. The remote and heterogeneous nature of the home care environment necessitates the use of non-intrusive client monitoring and a portable, point-of-care graphical user interface. Using a grounded theory approach, this article examines the simulated use of a graphical user interface by practitioners in a home care setting to explore the salient features of monitoring the activity of home care clients. The results demonstrate the need for simple, interactive displays that can provide large amounts of geographical and temporal data relating to patient activity. Additional emerging themes from interviews indicate that home care professionals would use a graphical user interface of this type for patient education and goal setting as well as to assist in the decision-making process of home care practitioners.

Prevalence of ciliated epithelium in apical periodontitis lesions.

INTRODUCTION: This article reports on the morphologic features and the frequency of ciliated epithelium in apical cysts and discusses its origin. METHODS: The study material consisted of 167 human apical periodontitis lesions obtained consecutively from patients presenting for treatment during a period of 12 years in a dental practice operated by one of the authors. All of the lesions were obtained still attached to the root apices of teeth with untreated (93 lesions) or treated canals (74 lesions). The former were obtained by extraction and the latter by extraction or apical surgery. Specimens were processed for histopathologic and histobacteriologic analyses. Lesions were classified, and the type of epithelium, if present, was recorded. RESULTS: Of the lesions analyzed, 49 (29%) were diagnosed as cysts. Of these, 26 (53%) were found in untreated teeth, and 23 (47%) related to root canal-treated teeth. Ciliated columnar epithelium was observed partially or completely lining the cyst wall in 4 cysts, and all of them occurred in untreated maxillary molars. Three of these lesions were categorized as pocket cysts, and the other was a true cyst. CONCLUSIONS: Ciliated columnar epithelium-lined cysts corresponded to approximately 2% of the apical periodontitis lesions and 8% of the cysts of endodontic origin in the population studied. This epithelium is highly likely to have a sinus origin in the majority of cases. However, the possibility of prosoplasia or upgraded differentiation into ciliated epithelium from the typical cystic lining squamous epithelium may also be considered.

Tophaceous pseudogout of the temporomandibular joint: a series of 3 cases.

OBJECTIVE: We report a series of 3 cases of tophaceous pseudogout of the temporomandibular joint (TMJ). STUDY DESIGN: Three patients, two men and one woman, ranging in age between 60 and 75 years, presented with unilateral painful swelling of the TMJ area associated with limitation of mouth opening. RESULTS: Radiographic and computed tomographic images showed opaque masses in the supracondylar region of the TMJ. The preoperative clinical impression was a "neoplastic lesion" in the 3 cases. Microscopic examination revealed numerous deeply basophilic masses of calcified deposits, exhibiting birefringence under polarized light and morphologically consistent with calcium pyrophosphate dihydrate deposition, referred to in these cases as "tophaceous pseudogout." CONCLUSION: Tophaceous pseudogout is a rare benign arthropathy that presents with clinical and radiographic features mimicking neoplastic conditions of the TMJ. Therefore, it is recommended that tophaceous pseudogout be considered in the differential diagnosis when a TMJ is involved with "neoplasm-like" lesions clinically and radiographically.

A non-independent energy-based multiple sequence alignment improves prediction of transcription factor binding sites.

MOTIVATION: Multiple sequence alignments (MSAs) are usually scored under the assumption that the sequences being aligned have evolved by common descent. Consequently, the differences between sequences reflect the impact of insertions, deletions and mutations. However, non-coding DNA binding sequences, such as transcription factor binding sites (TFBSs), are frequently not related by common descent, and so the existing alignment scoring methods are not well suited for aligning such sequences. RESULTS: We present a novel multiple MSA methodology that scores TFBS DNA sequences by including the interdependence of neighboring bases. We introduced two variants supported by different underlying null hypotheses, one statistically and the other thermodynamically generated. We assessed the alignments through their performance in TFBS prediction; both methods show considerable improvements when compared with standard MSA algorithms. Moreover, the thermodynamically generated null hypothesis outperforms the statistical one due to improved stability in the base stacking free energy of the alignment. The thermodynamically generated null hypothesis method can be downloaded from http://sourceforge.net/projects/msa-edna/. CONTACT: dov.stekel@nottingham.ac.uk. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

The genotype of RAET1L (ULBP6), a ligand for human NKG2D (KLRK1), markedly influences the clinical outcome of allogeneic stem cell transplantation.

NKG2D (KLRK1) is an activating receptor on natural killer (NK) and T-cells and binds a diverse panel of polymorphic ligands encoded by the MIC and RAET1 gene families. We studied the clinical importance of retinoic acid early transcript-1 (RAET1) polymorphism in allogeneic stem cell transplantation (SCT) by determining the frequency of 18 single nucleotide polymorphisms (SNPs) and individual RAET1 alleles in 371 patient-donor pairs and relating this to clinical outcome. A strong association was observed between the presence of five SNPs within the patient RAET1L (ULBP6) gene and relapse-free survival and overall survival. Two common alleles of RAET1L were determined and the presence of the protective RAET1L*02 allele in the patient was associated with a relapse-free survival of 44% at 8 years compared with just 25% in patients who lacked a RAET1L*02 allele (P < 0·001). Overall survival at this time was 55% in those with RAET1L*02 allele compared to 39% in patients who lacked a RAET1L*02 allele (P = 0·003). These novel findings indicate a critical role for NKG2D-RAET1L interactions in determining SCT clinical outcome and show RAET1L may have an important influence on regulating the strength of the alloreactive immune response. The data will be of value in guiding the development of future transplant therapy protocols.

Development of a rat model of bisphosphonate-related osteonecrosis of the jaw (BRONJ).

The purpose of this study was to develop a rat model predictive of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after exodontias. Thirty female rats were randomized into 2 groups, control and experimental. The experimental group received 2 intravenous injections of zoledronate (20 µg/kg). The mesial root of the right mandibular first molar was extracted. Rats were euthanized at 0, 4, and 8 weeks. Bone mineral density (BMD), collagen breakdown (pyridinium [PYD]), vascular regeneration (VEGF), and histology were examined. A trend toward higher PYD values was suggested in control vs experimental groups after wounding. Serum VEGF increased significantly after wounding for both control and experimental groups. After 8 weeks, VEGF continued to rise for the experimental group only. In the extraction socket area, BMD was significantly lower after wounding in control vs. zoledronate-treated rats. Histology sections from experimental groups showed bacteria and bone necrosis. Consistent findings of BRONJ features similar to those in humans were observed after zoledronate treatment.

Selection of an optimal treatment method for acute periodontitis disease.

The present paper is devoted to selection of an optimal treatment method for acute periodontitis by using fuzzy Choquet integral-based approach. We consider application of different treatment methods depending on development stages and symptoms of the disease. The effectiveness of application of different treatment methods in each stage of the disease is linguistically evaluated by a dentist. The stages of the disease are also linguistically described by a dentist. Dentist's linguistic evaluations are represented by fuzzy sets. The total effectiveness of the each considered treatment method is calculated by using fuzzy Choquet integral with fuzzy number-valued integrand and fuzzy number-valued fuzzy measure. The most effective treatment method is determined by using fuzzy ranking method.

[Epidemiological profile of children burns admitted at the National Center for Brules, Morocco]. / Profil epidemiologique des brulures d'enfants admis au Centre National des Brules, Maroc.

This retrospective study was performed in order to analyse the epidemiology and aetiology of 543 cases of paediatric burns and to determine the elements that might have contributed to their prevention, which remains the treatment of choice for this pathology. The paediatric hospitalization rate for burns was 45.7% (mean age, 4.25 yr), the highest proportion of patients (42.5%) being in the 1-5 yr age group. The male/female ratio in all age groups was 1.7/1. The environment where burn injury most commonly occurred was the home (85.1%), and with accidental causes, accounting for 96.5% of the causes (mainly liquids, 69.3%). The mean percentage of burned body surface area was 21% with a total burned body surface area of ≥ 20% in 52.3% of cases. The upper limbs (79.1%) were the most affected body site; and the children were referred from other hospitals in more than 6 h in 65.5% of cases. The mortality rate was 13.2%