The effect of aloe vera and tea tree oil mouthwashes on the oral health of school children.

PURPOSE: To evaluate the effect of two herbal mouthwashes containing aloe vera and tea tree oil, on the oral health of school children. METHODS: A double-blinded, placebo-controlled prospective interventional study was conducted in school children aged 8-14 years. The study participants were divided into four groups depending upon the mouthwash used: Group 1 (aloe vera), Group 2 (chlorhexidine), Group 3 (tea tree oil) and Group 4 (placebo). The variables studied included plaque index, gingival index and salivary Streptococcus mutans counts, which were recorded at baseline, 4 weeks after supervised mouth rinse and after 2 weeks of stopping the mouth rinse. RESULTS: A total of 89 boys and 63 girls were included. A statistically significant decrease in all variables was noted after the use of both the herbal preparations at the end of 4 weeks which was maintained after the 2-week washout period (p < 0.001). The difference in variables between groups using aloe vera, Tea tree oil and chlorhexidine, was not statistically significant. CONCLUSION: The use of aloe vera and tea tree oil mouthwashes can decrease plaque, gingivitis and S. mutans in the oral cavity in children. The activity of these two agents is comparable to that of chlorhexidine.

Clinical and Genetic Profile of Indian Children with Primary Hyperoxaluria.

Primary hyperoxaluria (PH) has heterogeneous renal manifestations in infants and children. This often leads to delay in diagnosis. In the past 3 years, genetic samples were sent for seven children with a clinical diagnosis of PH. Their medical records were reviewed for clinical presentation and outcomes. Of the seven children, three were males. The median age of presentation was 4.9 years with the youngest presenting at 3 months of age. Nephrolithiasis, the most common presentation was associated with renal dysfunction in two children. Two children with no significant history presented in end-stage renal disease (ESRD). The sibling of one of the children in ESRD, with a history of consanguinity in parents, was screened for asymptomatic nephrolithiasis. Bilateral multiple renal calculi were found in majority of children followed by echogenic kidneys on ultrasound examination. Genetic analysis suggested PH Type 1 in five children and type 2 in two children. The mutations detected in our cohort were different from the previously reported common mutations. There was no obvious genotype-phenotype correlation noticed. Three children in ESRD are on maintenance dialysis. Nephrolithiasis being a common presentation of PH needs prompt evaluation. Mutations are generally population specific, and whole gene sequence analysis is critical in diagnosis.

EVALUATION OF MULTIPLEX LIGATION DEPENDENT PROBE AMPLIFICATION AS A TOOL FOR DIAGNOSIS AND CARRIER DETECTION IN FAMILIES WITH A DYSTROPHINOPATHY.

We set out to evaluate multiplex ligation dependent probe amplification (MLPA) as a tool for diagnosis and carrier detection in families with a dystrophinopathy. Fifty three Indian families with provisional diagnosis of Duchene muscular dystrophy or Becker muscular dystrophy were evaluated by MLPA and multiplex polymerase chain reaction (PCR). Sanger sequencing was used to analyze the entire gene in one patient. Mothers were tested for carrier status whenever possible. Molecular analysis of DMD gene by combining MLPA and multiplex PCR yielded a mutation detection rate of 62% (33/53). Deletions were detected in 27/53 (51%) cases, duplications in 5/53 (9%) cases, a small deletion one case and Sanger sequencing detected a nonsense mutation in one case. Mutation was not detected in 36% (19/53) cases. Fifty six percent of mothers (9/16) were found to be carriers. MLPA helped to refine the results of multiplex PCR testing in 22 patients (5 duplications, 16 deletions and one small deletion). We also describe a situation where a deletion of single exon on MLPA (but not detected by multiplex PCR) was actually due to a deletion of two nucleotides in the probe ligation site. MLPA appears to score over multiplex PCR in diagnosis and carrier detection, specifically by detecting deletions and duplications that are not detected by traditional multiplex PCR.

Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome.

Cyclosporine A (CyA) is an effective agent for the treatment of glucocorticoid-dependent idiopathic nephrotic syndrome (GCDNS), but costs are prohibitive in resource-poor societies. The objectives of this study were to evaluate the efficacy and safety of reducing the dose of CyA by co-administering ketoconazole. A prospective study targeting children 2-18 years of age with GCDNS in remission with CyA monotherapy was conducted. CyA dose was reduced by 50% and ketoconazole was added at 25% of the recommended therapeutic dose, and the drug levels and therapeutic and adverse effects (AE) were monitored. Continued combined therapy after completion of the 4-week trial period was offered. Ten patients (median age 9.5 years, range 3.0-16.0 years) were enrolled in the study. At week 4, the CyA dose was 2.2 ± 0.7 mg/kg/day compared with 5.6 ± 0.9 mg/kg/day at enrolment (P < 0.0001). No AE were noted. All patients continued ketoconazole treatment for at least 3 months. CyA drug cost savings were 61%, and approximately 60% with ketoconazole cost included. The combination of an expensive immunosuppressive drug with a cheap metabolic inhibitor reduced the treatment costs by> 50% without increased adverse events or drug monitoring needs. This intervention demonstrates how access of patients with limited resources to needed drugs can be improved by interference with physiological drug elimination.

Extending psychosocial assessment of patients with psoriasis in the UK, using a self-rateds, web-based survey.

BACKGROUND: Quality of life self-rating using a web-based survey has not previously been evaluated for psoriasis in the UK. AIM: To use an open-access web-based survey to assess the effect of psoriasis on patients' daily life. Methods. The survey was conducted using a dedicated website endorsed by a UK psoriasis patient charity. RESULTS: In total, 1760 patients (1102 women, 658 men; median age range 40-44 years) assessed their psoriasis using the website. Psoriasis was 'very' or 'extremely' active in 52%, and 71% had been diagnosed > 10 years previously. Psoriasis had negatively affected the working life of 59% of patients, and the educational performance of 31%. CONCLUSIONS: The use of an open-access web-based survey may address potential bias in previous studies, but may itself introduce a bias towards younger patients. This is the first report of a web-based survey of UK patients with psoriasis, providing further recent evidence of how psoriasis affects patients' lives.

Unusual presentation of duodenal Dieulafoy's lesion in a toddler.

Dieulafoy's lesion is a rare cause of massive upper gastrointestinal haemorrhage in any age. It predominantly occurs in the proximal stomach. We report on a child who presented with massive rectal haemorrhage and a clear nasogastric aspirate due to duodenal Dieulafoy's lesion.

Urinary indices during relapse of childhood nephrotic syndrome.

Sodium retention is the hallmark of idiopathic nephrotic syndrome (INS). Sodium retention could be secondary to activation of renin-angiotensin-aldosterone axis or due to an intrinsic activation of Na(+)K(+) ATPase in the cortical collecting duct. Urine potassium/urine potassium + urine sodium (UK(+)/UK(+) + UNa(+)) is a surrogate marker for aldosterone activity and can be useful in differentiating primary sodium retention from secondary sodium retention in children with INS. This was a cross-sectional study of children with INS, presenting to our center from June 2007 to June 2008. Children were categorized into those with steroid responsive and steroid nonresponsive nephrotic syndrome. One hundred and thirty-four children with nephrotic syndrome were analyzed. The FeNa(+) was significantly lower during relapse than in remission but no such difference was observed with UK(+)/UK(+) + UNa(+). The values of FeNa(+) and UK(+)/UK(+) + UNa(+) across various categories of nephrotic syndrome were similar. Correlating FeNa(+) and UK(+)/UK(+) + UNa(+) with cut-off of 0.5 and 60%, respectively, we found 50% of steroid responsive children and 36% of steroid nonresponders having a corresponding UK(+)/UK(+) + UNa(+) of <60% along with low FeNa(+) of <0.5%, favoring primary sodium retention. Urinary indices did not vary with the type of steroid response. In early relapse, the urinary indices revealed an overlap of both primary and secondary sodium retention in most stable edematous children with nephrotic syndrome.

Acute graft pyelonephritis following renal transplantation.

BACKGROUND: Urinary tract infection is the most common form of bacterial infection encountered in a renal transplant recipient. Studies explaining the long-term consequences of acute graft pyelonephritis (AGPN) are few. METHODS: A total of 1022 consecutive renal allograft recipients were studied retrospectively over a period of 10 years for evidence of AGPN. These patients were classified into two groups according to the presence or absence of at least one AGPN episode. Only culture-proven infections were included in the study. RESULT: Of the 1022 renal transplant recipients, 169 patients (16.5%) developed AGPN. In the multivariate analysis with stepwise logistic regression, significant associations were observed between AGPN and placement of ureteric stent (odds ratio [OR]=4.6), urological malformations of native kidney (OR=2.1), cytomegalovirus (CMV) disease (OR=2.0), mycophenolate mofetil (MMF)-based regimen (OR=1.9), and acute rejection episodes (OR=1.5). However, age>40 years, female gender, induction therapy, anti-CD3 treatment, and hyperglycemia did not show such an association. In comparison with the non-AGPN group, these patients had a lower graft and patient survival (though it did not attain statistical significance). In the multivariate analysis using the Cox model for the entire study population, AGPN did not independently contribute to poor graft or patient survival. CONCLUSION: AGPN in the renal transplant setting is an ominous event, as these patients are also more prone to develop bacteremia, acute rejection, and CMV disease, which could then lead to poor graft and patient survival. Its association with MMF needs further clarification.

Absence of Borrelia burgdorferi DNA in cutaneous B-cell lymphomas from the United States.

BACKGROUND: An association between Borrelia burgdorferi and cutaneous B-cell lymphoma (CBCL) has been made in several European countries. The evidence in favor of such an association has recently been based on more definitive tests for the pathogenetic role of B. burgdorferi in CBCL, including positive cultures or polymerase chain reaction (PCR) amplification of borrelial DNA from lesional skin. However, there is only one report of B. burgdorferi in four North American cases of B-cell lymphoma. METHODS: We retrieved 38 cases of primary and secondary CBCL from different geographic regions of the United States. Two separate techniques were used to detect borrelial DNA by PCR, a nested PCR method to amplify a B. burgdorferi-specific gene as well as a borrelial chromosomal Ly-1 clone amplification method. Southern blot hybridization was used for confirmation of the PCR results. RESULTS: No B. burgdorferi-specific DNA was detected in any of the 38 CBCL cases, whereas detectable PCR products were obtained with our positive controls. CONCLUSIONS: Our findings, in light of previous studies, suggest that B. burgdorferi plays a minimal role in the development or pathogenesis of CBCL in the United States. The findings also suggest that the geographic variations in the clinical manifestations of B. burgdorferi are indeed real and may be secondary to the genetic and phenotypic differences between B. burgdorferi strains present in Europe and North America.

Disease concomitance in psoriasis: a clinical study of 61 cases.

Sixty-one patients with psoriasis were studied for concomitant diseases and compared with 61 age and sex-matched controls. Concomitant cutaneous diseases most often seen with psoriasis were lichen simplex chronicus (16.3%), verruca vulgaris (9.8%) and me Iasina (4.9%). Of the systemic disorders, diabetes showed the highest frequency (13.1%) followed by hypertension (8.1%). Two patients had HIV infection (3.2%). Both the patients had severe and atypical lesions.

When is surgical treatment not appropriate for morphea?

Morphea is an inflammatory cutaneous disease that can be mistaken for a soft-tissue neoplasm. The authors report two cases of morphea that were resected surgically before the histological diagnosis of morphea was rendered. One of the patients had a recurrence of morphea around her large surgical scar. They present these cases to alert surgeons to the pitfall of inappropriate surgical treatment of an inflammatory condition.

Genistein inactivates bcl-2, delays the G2/M phase of the cell cycle, and induces apoptosis of human breast adenocarcinoma MCF-7 cells.

The aim of this study was to identify the molecular mechanism of action of the isoflavone, genistein. Genistein at 0.15 mM caused MCF-7 apoptotic cell death, which was accompanied by cell cycle delay in the G2/M phase. Twenty-four hours post-treatment, 47.3% of the MCF-7 cells accumulated at G2/M, compared with 19.9% in the untreated controls. At 0.15 mM, genistein caused an increase in the steady-state levels of the wild-type tumour suppressor p53, which was attributed to stabilising the tumour suppressor protein, since p53 mRNA levels did not increase. Prior to the upregulation of p53, which became evident within 6 h of genistein treatment, there was increased bcl-2 phosphorylation at 30 min post-treatment. Although early changes (30-120 min) in the phosphotyrosine peptide patterns were not detected, after 24h, genistein inhibited phosphorylation of several peptides. These results suggest that genistein's dual roles of protein tyrosine kinase inhibitor and topoisomerase II inhibitor are essential for the initiation of apoptosis.

Nail changes in systemic diseases : A clinical study of 435 cases.

Nail changes often are reflectors of an internal disease. Four hundred and thirty-five patients admitted in the Medical, Surgical and Obstetric and Gynaecology wards were studied. Nail changes were seen in 134 which included clubbing (21.3%) longitudinal melanonychia (17.2%) and platonychia (14.2%). In patients with HIV associated pulmonary tuberculosis, clubbing was associated with an unique red "crescent sign".

WR-1065, an active metabolite of the cytoprotector amifostine, affects phosphorylation of topoisomerase II alpha leading to changes in enzyme activity and cell cycle progression in CHO AA8 cells.

The effects of WR-1065 (2-((aminopropyl)amino)ethanethiol) on cell cycle progression, topoisomerase (topo) II alpha activity, and topo II alpha phosphorylation in Chinese hamster ovary (CHO) cells have been investigated. Exposure of CHO cells to 0.4 microM of WR-1065 for 30 min did not effect cell cycle progression nor topo II alpha activity and phosphorylation status. However, concentrations ranging from 4 microM to 4 mM were equally effective in significantly altering these three end points. Cell cycle progression was analysed by flow cytometry. Following a 30 min exposure to this range of concentrations, cells redistributed throughout the cell cycle with the most prominent changes being an accumulation of cells in G2. Topo II alpha activity was measured using a kinetoplast DNA (kDNA) decatenation assay. Enzyme activity was reduced by 50% relative to control levels throughout the 4 microM to 4 mM dose range tested. Likewise, topo II alpha phosphorylation levels, analysed using an immunoprecipitation assay and an antibody specific to the 170 kDa band of topo II, decreased between 42% to 48% of control levels. Inhibition of topo II alpha activity in cells exposed to WR-1065 is consistent with the associated observation of WR-1065 mediated cell cycle progression delay and build-up of cells in the G2 phase of the cell cycle.

Intubating conditions and neuromuscular block after divided dose mivacurium or single dose rocuronium.

PURPOSE: To evaluate the tracheal intubating conditions and neuromuscular blocking characteristics of divided dose mivacurium or single dose rocuronium. METHODS: Thirty-two patients undergoing elective surgery were studied. Anaesthesia was with propofol 2 mg.kg-1, followed by an infusion of 150 micrograms.kg-1.min.1. Patients were randomized to receive either mivacurium-0.15 mg.kg-1 followed 30 sec later by 0.1 mg.kg-1, or rocuronium- 0.9 mg.kg-1, followed 30 sec later by placebo. Tracheal intubating conditions were assessed 90 sec after the initial dose of relaxant by an anaesthetists who was unaware of patient group. The electromyographic (EMG) response of the first dorsal interosseus muscle to ulnar nerve train-of-four was measured. RESULTS: Successful tracheal intubation was performed in all patients after both mivacurium and rocuronium. Intubating conditions (jaw relaxation, open visible vocal cords) were judged to be good-excellent in all but one patient before insertion of the tracheal tube. However, patients receiving mivacurium were more likely to experience coughing and bucking after tracheal tube insertion (10/16 patients) than those receiving rocuronium (3/16 patients, P < 0.05). No patient in the rocuronium group experienced moderately vigorous coughing and bucking after insertion of the tracheal tube vs six patients in the mivacurium group (P < 0.05). Time to 10 and 25% recovery of neuromuscular function was faster (P < 0.05) after divided dose mivacurium (20 +/- 1 and 23 +/- 1 min, respectively) than after rocuronium (45 +/- 5 and 57 +/- 8 min, respectively). CONCLUSION: The results suggest that, during conditions of the study, divided dose mivacurium is not recommended for a 90-sec tracheal intubation in patients where moderate coughing and bucking is deemed unacceptable.

Cutaneous manifestations of HIV infection.

A total of 32 patients with HIV infection were examined for cutaneous manifestations from September 1994 to December 1995 in the Dermatology and Venereology Department of Wenlock District Hospital, Mangalore. Xerosis was the commonest skin manifestation (50%). Oropharyngeal candidiasis was an indicator of grave prognosis in 4 patients. Seborrhoeic dermatitis, seen is in 15.6%, presented in an atypical, extensive and rapidly evolving form. Infections were atypical, extensive and did not respond to conventional modalities of treatment.

Commitment to erythroid differentiation in mouse erythroleukemia cells is controlled by alterations in topoisomerase II alpha phosphorylation.

To explore the program of cell differentiation in Friend murine erythroleukemia (MEL) cells, we used three clonal variants: phorbol 12-myristate 13-acetate (PMA)-hypersensitive TS-19-101, PMA-resistant TR19-9, and hexamethylene bis-acetamide (HMBA)- and PMA-resistant DS19/R1. After treating TS19-101 cells with HMBA, topoisomerase II (topo II) enzymatic activity was dramatically reduced, and cells became terminally differentiated. The initial reduction in activity was soon followed by reduced topo II alpha phosphorylation, but only later did the protein level drop significantly. PMA, which completely blocked HMBA-induced differentiation in TS19-101 cells, increased the phosphorylation of topo II alpha and restored the enzymatic activity to its original levels. Reduced topo II activity and phosphorylation were also evident in HMBA-treated TR19-9 cells. PMA failed to restore topo II activity and phosphorylation to their original levels in TR19-9 cells. Predictably, the topo II activity and phosphorylation of DS19/R1 cells showed little change in response to HMBA or PMA treatment. Structural changes in chromatin became evident in sensitive cells 24 h after HMBA treatment, suggesting that alterations in topo II alpha phosphorylation may control cell differentiation by altering nuclear architecture.