Removal of Six Esophageal Metals in a Four-Month-Old Infant: A Rare Case.

This case report details the distinctive and demanding clinical situation involving a four-month-old female neonate. Her chief complaint was a two-day refusal to consume food orally, accompanied by episodes of vomiting following feedings and a sensation of choking in the throat. The referring physician suspected the presence of a foreign body in the patient's esophagus and advised a chest X-ray following a thorough examination. The presence of six hyperdense metallic foreign bodies in the upper, mid, and distal dorsal esophagus was confirmed by subsequent CT thorax imaging. This case was managed through the implementation of a multidisciplinary strategy. A decision was reached to conduct an endoscopic assessment; a substantial foreign object resembling a boulder was detected throughout the procedure, resulting in total obstruction of the esophageal lumen. Despite some challenges, this foreign object was effectively extracted by utilizing a Dormia basket. After that, endoscopy was used to detect five more metallic foreign bodies, all successfully eliminated endoscopically. The postoperative course was characterized by the 24-hour prophylactic Ryles tube insertion, followed by the resumption of breastfeeding. The infant's recovery and positive attitude on the second day following the operation indicate the case's successful resolution, emphasizing the criticality of a timely intervention in similar circumstances. This report underscores the clinical management and treatment of multiple metallic foreign bodies in a pediatric patient while also stressing the importance of prompt diagnosis and interprofessional collaboration in complex and exceptional cases.

An Unusual Intraosseous Swelling of the Jaw: Two Rare Case Reports.

Neurofibroma is the most common type of peripheral nerve neoplasm arising from a mixture of cell types, including schwann cells and perineurial fibroblasts. We report two unusual cases where patients presented with intraosseous swelling of the jaw. A complete examination followed by Imaging and histopathological examination were advised. Imaging showed ill-defined radiolucency in one case and well defined corticated radiolucency with soap-bubble appearance in the other case. Biopsy with adjuvant immunohistochemistry revealed features suggestive of neurofibroma. Both cases were managed surgically. The second case in the male patient, also showed multiple recurrences and subsequent transformation into atypical neurofibroma. In spite of being a benign tumor, neurofibroma is locally aggressive. Commonly found in soft tissues of the body, neurofibromas are rare in the head and neck region. But the intraosseous location of this tumor in the mandible is an exceptional case.

Papilliferous Keratoameloblastoma: Systematic review.

Papilliferous keratoameloblastoma (PKA) is a rare entity, and not much is known about its clinicodemographic features or biological nature. This review aimed to provide clarity regarding the characterisation of the demographic, clinical, radiological and histopathological features of PKA. Case reports of PKA were identified through a systematic search across multiple databases. The search yielded a total of 10 cases, half of which were of Indian origin. All the cases invariably occurred in the mandibular posterior region and involved the right side; only one case primarily involved the left side of the mandible. PKA should be considered a variant of the conventional ameloblastoma that is towards the more aggressive end of the spectrum. It tends to occur in older individuals (in their fifth decade or older), with a marked propensity to occur in the right mandibular posterior region. Surgical resection with diligent follow-up is warranted in the treatment of PKA.

Lactadherin's Multistate Binding Predicts Stable Membrane-Bound Conformations of Factors V and VIII's C Domains.

Protein binding to negatively charged lipids is essential for maintaining numerous vital cellular processes where its dysfunction can lead to various diseases. One such protein that plays a crucial role in this process is lactadherin, which competes with coagulation factors for membrane binding sites to regulate blood clotting. Despite identifying key binding regions of these proteins through structural and biochemical studies, models incorporating membrane dynamics are still lacking. In this study, we report on the multimodal binding of lactadherin and use it to gain insight into the binding mechanisms of its C domain homologs, factor V and factor VIII. Molecular dynamics simulations enhanced with the highly mobile mimetic model enabled the determination of lactadherin's multimodal binding on membranes that revealed critical interacting residues consistent with prior NMR and mutagenesis data. The binding occurred primarily via two dynamic structural ensembles: an inserted state and an unreported, highly conserved side-lying state driven by a cationic patch. We utilized these findings to analyze the membrane binding domains of coagulation factors V and VIII and identified their preferred membrane-bound conformations. Specifically, factor V's C domains maintained an inserted state, while factor VIII preferred a tilted, side-lying state that permitted antibody binding. Insight into lactadherin's atomistically resolved membrane interactions from a multistate perspective can guide new therapeutic opportunities in treating diseases related to blood coagulation.

Recurrent Strokes in a Patient With Metastatic Lung Cancer.

A stroke, also known as cerebrovascular accident (CVA), is a medical condition that occurs when the blood supply to the brain is interrupted, resulting in brain cell death. Cancer-associated stroke (CAS) is a rare but serious complication of cancer, where a malignant tumor or its metastases invade or compress the blood vessels in the brain, resulting in a stroke. We describe a case of a 60-year-old male patient recently diagnosed with lung cancer with metastasis to the liver, esophagus, small intestine, and pancreas who has had at least three CVAs within a span of three months. He developed sequelae such as hemiplegia and aphasia. He was managed with dual antiplatelet therapy, neuroprotective drugs, and physiotherapy. Patients with advanced cancers should be routinely screened for neurovascular complications and risks. Prophylactic therapy should be started wherever warranted.

Rare variant analyses across multiethnic cohorts identify novel genes for refractive error.

Refractive error, measured here as mean spherical equivalent (SER), is a complex eye condition caused by both genetic and environmental factors. Individuals with strong positive or negative values of SER require spectacles or other approaches for vision correction. Common genetic risk factors have been identified by genome-wide association studies (GWAS), but a great part of the refractive error heritability is still missing. Some of this heritability may be explained by rare variants (minor allele frequency [MAF] ≤ 0.01.). We performed multiple gene-based association tests of mean Spherical Equivalent with rare variants in exome array data from the Consortium for Refractive Error and Myopia (CREAM). The dataset consisted of over 27,000 total subjects from five cohorts of Indo-European and Eastern Asian ethnicity. We identified 129 unique genes associated with refractive error, many of which were replicated in multiple cohorts. Our best novel candidates included the retina expressed PDCD6IP, the circadian rhythm gene PER3, and P4HTM, which affects eye morphology. Future work will include functional studies and validation. Identification of genes contributing to refractive error and future understanding of their function may lead to better treatment and prevention of refractive errors, which themselves are important risk factors for various blinding conditions.

Evaluation of Expression Of ADAM 10 as a Predictor of Lymph Node Metastasis in Oral Squamous Cell Carcinoma-An Immunohistochemical Study.

BACKGROUND: Lymph node metastasis (LNM) is a well-known prognostic factor in Oral Squamous Cell Carcinoma(OSCC). A biological marker that predicts the Lymph Node Metastasis (LNM) in OSCC cases is the need of the hour. A Disintegrin And Metalloproteinases (ADAMs), a family of proteins that exhibit a metalloproteinase domain play a pivotal role in the pathogenesis of tumor growth and metastasis. This study aims to evaluate whether ADAM 10 can be used as a predictor of lymph node metastasis in OSCC using immunohistochemistry. METHOD: A total of 90 samples that were categorized into 3 groups were included in the present study. Group I consisted of 30 samples of the normal oral mucosa, and Group II consisted of 30 samples of OSCC without lymph node metastasis. Group III consisted of 30 samples of OSCC with lymph node metastasis. Esophageal Squamous Cell Carcinoma was used as external positive control. Immunohistochemical expression of ADAM10 in their corresponding stained sections was assessed and staining intensity was calculated. RESULTS: ADAM10 immunoreactivity was considered positive when located in cytoplasm or membrane or both. This method is similar to that used by Bamane et al. for OSCC cases. The mean value of the Staining Index score "AxB" was highest in Group III (7.90), followed by Group II (3.13) and least in Group I (0.27). These values were statistically significant. CONCLUSION: Considering the findings of a higher percentage of ADAM10 positive cells, higher staining intensity, and higher staining index, the overexpression of ADAM10 can be used as an independent marker for OSCC patients to predict the lymph node metastasis.

Prevalence of oral neurofibroma in Central Indian population: A retrospective study of 20 years.

CONTEXT: Neurofibroma is a benign peripheral nerve sheath tumor. Commonly found in the peripheral soft tissues, it can manifest as a solitary mass or as a component of neurofibromatosis. AIMS: The purpose of the retrospective cross-sectional study was contributing to the literature by providing data about the prevalence of oral neurofibroma in Central Indian population. SETTINGS AND DESIGN: Retrospective, cross-sectional study. SUBJECTS AND METHODS: All histopathologically diagnosed cases of oral neurofibroma were retrieved from the archives of our department and were reviewed. All the cases that met the inclusion criteria were reviewed in terms of the year when the patient reported, patient's age, gender, location of the lesion, i.e., soft tissue or intraosseous, clinical appearance, i.e., growth or swelling, histopathologic diagnosis and immunohistochemistry results if available. The results were aggregated and described qualitatively using Microsoft Excel 2013. RESULTS: In our retrospective analysis of 20 years (2000-2019), we came across 14 reported cases of oral neurofibroma, in five males and nine females. Two of these cases showed a recurrent nature and one case showed transformation into atypical neurofibroma. Two cases were encountered in the mandible as an intraosseous oral neurofibroma. CONCLUSIONS: In our study, we found that oral neurofibroma was more common in the third decade with a female predilection. Gingiva was the most common site. Of the 14 cases that were encountered, two cases showed recurrence and one case showed malignant transformation. Hence, in spite of being a benign neoplasm, oral neurofibroma is locally aggressive and should be diagnosed accurately.

Sociodemographic and behavioral factors associated with early childhood caries among preschool children of Western Maharashtra.

INTRODUCTION: Early childhood caries is a preventable disease of multifactorial etiology and is a public health problem affecting majority of the preschool-age children of the country. If left untreated, it has many social, economic, and nutritional implications and affects the quality of life of the affected child. METHODS: This cross-sectional study was conducted among 200 preschool children of Karad city, western Maharashtra, to assess the prevalence of dental caries among the preschool children and to assess the factors affecting the development of dental caries. Various child-level, parent-level, attitudinal- and family-level factors, and clinical variables were evaluated. RESULTS: High prevalence of caries of 87.5% was observed in the study sample. Bivariate analysis showed a significant association of age of child (P < 0.001), age of mother at birth (P = 0.041), feeding during 1st year (P = 0.034), snacking habits (P = 0.001), and brushing frequency (P = 0.03) with dental caries. On multivariate analysis, the factors of snacking habits (P = 0.003) and age of child (P = 0.002) remained significantly correlated with dental caries. CONCLUSION: There was a strong and consistent relation of the snacking habits with the prevalence of dental caries among the preschool children of Karad city. There is a need to sensitize the caregivers regarding the role of frequent snacking in dental caries.