Comparative evaluation of vestibular incision subperiosteal tunnel access with platelet-rich fibrin and connective tissue graft in the management of multiple gingival recession defects: A randomized clinical study.

BACKGROUND: The etiology of gingival recession is often multifactorial. Wide array of surgical techniques are available to manage gingival recession. The aim of the present study was to compare, minimally invasive approach (vestibular incision subperiosteal tunnel access [VISTA]), in combination with platelet-rich fibrin (PRF) and connective tissue graft (CTG) in the management of multiple recession defects in maxillary anterior region. MATERIALS AND METHODS: A total of 32 sites from 10 systemically healthy controls were allocated randomly to VISTA with PRF (VISTA + PRF) and VISTA with CTG (VISTA + CTG). Plaque index, gingival index, Probing probing pocket depth (PPD), relative attachment level (RAL), recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and percentage of root coverage (%RC) were calculated at 6 months postoperatively. RESULTS: Results showed significant improvement in mean PPD, RAL, RD, RW, and KTW. %RC in VISTA + PRF and VISTA + CTG was 83.25% ± 25.02% and 86.43% ± 22.79%, respectively, at 6 months. There were no significant differences in the parameters between the VISTA + PRF and VISTA + CTG groups. CONCLUSION: VISTA is a minimally invasive surgical approach, which can be combined with CTG or PRF in the management of Miller's Class I and Class II recession defects, with predictable outcomes. There were significant improvements in the clinical parameters from baseline to 6 months in both the groups. To match with the CTG, which is the gold standard procedure, PRF can be used as an alternative for treating multiple recession defects.

Submitral aneurysm in children: A rare entity with varied presentation!

We present echocardiographic images in two children with a diagnosis of submitral aneurysm. Both had absolutely different presentations. The diagnosis was established on echocardiography and no advanced imaging techniques were used.

Late perforation of Durata ICD lead--a case report.

Late ICD lead perforation is an uncommon but clinically significant complication. The pathophysiology, predictors, clinical presentations and management although have been described earlier but still remain inconclusive. Our case highlights the challenges involved in clinical recognition, the value of CT scan in its diagnosis and need for careful management of this potentially life threatening condition. It is the first report on Durata lead perforation to the best of our knowledge.

Early antenatal serum lipid levels and the risk of pre-eclampsia in Trinidad and Tobago.

OBJECTIVE: To determine the lipid levels in early pregnancy and the risk for pre-eclampsia in a Trinidad population. METHODS: Prospective cohort study comprised 156 pregnant women attending antenatal clinic visits prior to 20 weeks at an average of 14 weeks. Blood samples were analysed for lipid levels. Of which 102 participants were followed until delivery and were monitored for pre-eclampsia. Data was analysed using univariate linear and stepwise logistic regression analysis. RESULTS: In the study 11 women developed pre-eclampsia and 91 remained normal. Mean triglyceride levels were found significantly higher in the pre-eclampsia group (p = 0.001). Mean HDL levels were low and LDL/HDL ratios were high in pre-eclampsia group. Women with triglycerides above 130 mg/dL had increased risk of pre-eclampsia (adjusted OR 14.046; 95% CI 1.254-157.334) compared with those with triglycerides levels 91 mg/dL or less. CONCLUSION: Increased serum triglyceride levels in early pregnancy before 20 weeks are associated with pre-eclampsia.

Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure.

BACKGROUND: In recent large paediatric cardiomyopathy population studies from North America and Australia, vitamin D deficiency was not identified as a cause of infant heart failure. However, rickets is resurgent in developed countries. OBJECTIVE: To review the prevalence of this cardiomyopathy in paediatric cardiology units of southeast England and determine the prognosis. METHODS AND RESULTS: A retrospective review from 2000 to 2006 in southeast England. Sixteen infants (6 Indian subcontinent, 10 black ethnicity) were identified: median (range) age at presentation was 5.3 months (3 weeks-8 months). All had been breast fed. Ten presented at the end of the British winter (February-May). Median shortening fraction was 10% (range 5-18%) and median left ventricular end diastolic dimension z score was 4.1 (range 3.1-7.0). Six had a cardiac arrest; three infants died. Eight were ventilated, two required mechanical circulatory support and 12 required intravenous inotropic support. Two were referred for cardiac transplantation. Median (range) of biochemical values on admission was: total calcium 1.5 (1.07-1.74) mmol/l; alkaline phosphatase 646 (340-1057) IU/l; 25-hydroxyvitamin D 18.5 (0-46) nmol/l (normal range >35) and parathyroid hormone 34.3 (8.9-102) pmol/l (normal range <6.1). The clinical markers and echocardiographic indices of all survivors have improved. The mean time from diagnosis to achieve normal fractional shortening was 12.4 months. CONCLUSIONS: Vitamin D deficiency and consequent hypocalcaemia are seen in association with severe and life-threatening infant heart failure. That no infant or mother was receiving the recommended vitamin supplementation highlights the need for adequate provision of vitamin D to ethnic minority populations.

Response to bosentan in children with pulmonary hypertension.

OBJECTIVE: To describe an early experience of treating 40 children with the dual endothelin receptor antagonist bosentan, which is known to be safe and effective in adults with pulmonary hypertension (PH). DESIGN: In this retrospective, observational study the UK Service for Pulmonary Hypertension for children treated 40 children with bosentan, 20 with idiopathic pulmonary arterial hypertension (IPAH) (mean age 8.03 years, range 1.2-17) and 20 with PH associated with other conditions (congenital heart disease, parenchymal lung or connective tissue disease, or HIV). Their mean age was 8.3 years (range 0.6-16 years). PATIENTS: 39 patients were in World Health Organization (WHO) class III and IV, and all had shown recent deterioration. In IPAH the mean pulmonary vascular resistance (PVR) was 21.7 units.m2 (range 5.6-42.8). In secondary PH the mean PVR was 18 units.m2 (range 4.9-49). No child had a positive response to vasodilator testing with nitric oxide. INTERVENTIONS: Bosentan was given as first line treatment to 25. Nine were given intravenous epoprostenol. Children were treated for a mean of 12.7 months (range 2-24 months). MAIN OUTCOME MEASURES: Response to treatment was judged by WHO functional class, six minute walk test, weight, ECG and echocardiographic findings, and need to add additional treatment. RESULTS: Bosentan was well tolerated. In the IPAH group 19 (95%) stabilised with bosentan treatment but 12 (60%) patients needed combined treatment with epoprostenol. In secondary PH, WHO class, six minute walk test, and weight gain improved significantly. CONCLUSION: Bosentan helped stabilise children with IPAH but intravenous epoprostenol was also needed by 60%. Children with secondary PH improved.

Cough plate versus cough swab in patients with cystic fibrosis; a pilot study.

BACKGROUND: Accurate identification of lower respiratory tract pathogens is important in the management of cystic fibrosis patients. AIM: To evaluate the cough plate as an alternative method of obtaining respiratory samples for microbiological culture. METHODS AND RESULTS: Using sputum culture as the "gold standard", the cough plate method identified significantly more positive cases than either dry or moistened cough swabs. Of 20 patients who had a positive sputum culture, 16 had a positive culture on cough plate compared to seven positive cultures each on moistened swab and on dry swab respectively. CONCLUSIONS: In this study cough plates were more sensitive than cough swabs in isolating respiratory pathogens in sputum producers. As patients prefer it, the cough plate merits further evaluation, particularly in non-sputum producers.

Genetic variability of begomoviruses associated with cotton leaf curl disease originating from India.

Cotton leaf curl disease (CLCuD) causing viruses belong to the Begomovirus genus of the family Geminiviridae. Most begomoviruses are bipartite with two molecules of circular single stranded DNA (A and B) encapsidated in icosahedral geminate particles. However, the begomoviruses associated with CLCuD have DNA-beta instead of DNA-B. In this communication we report the complete genomic sequence of DNA-A component of two CLCuD-causing begomoviruses, cotton leaf curl Kokhran virus-Dabawali (CLCuKV-Dab), tomato leaf curl Bangalore virus-Cotton [Fatehabad] (ToLCBV-Cotton [Fat]) and partial sequences of two other isolates cotton leaf curl Rajasthan virus-Bangalore (CLCuRV-Ban) and cotton leaf curl Kokhran virus-Ganganagar (CLCuKV-Gang). A phylogenetic analysis of these isolates along with other related begomoviruses showed that ToLCBV-Cotton [Fat] isolate was closest to the tomato leaf curl Bangalore virus-5 (ToLCBV-Ban5) where as CLCuKV-Dab isolate was close to the cotton leaf curl Kokhran virus-Faisalabad1 (CLCuKV-Fai1), cotton leaf curl Kokhran virus-72b (CLCuKV-72b) and cotton leaf curl Kokhran virus-806b (CLCuKV-806b) isolates from Pakistan. The phylogenetic analysis further showed that the ToLCBV-Cotton [Fat] and CLCuKV-Dab isolates along with CLCuKV-Fai1, CLCuKV-72b and CLCuKV-806b are closer to the ToLCBV, tomato leaf curl Gujarat virus (ToLCGV), tomato leaf curl Gujarat virus-Varanasi (ToLCGV-Var) and tomato leaf curl Sri Lanka virus (ToLCSLV) isolates, where as cotton leaf curl Alabad virus-804a (CLCuAV-804a), cotton leaf curl Multhan virus (CLCuMV) cluster with the isolates from cotton leaf curl Rajasthan virus (CLCuRV) and okra yellow vein mosaic virus (OYVMV). These results demonstrate the extensive variability observed in this group of viruses. The AC4 ORF is the least conserved among these viruses. In order to further asses the variability in the CLCuD-causing begomoviruses, the region showing minimum similarity in the DNA-A sequence was first determined by a comparison of segments of different lengths of the aligned sequences. The results indicated that region 2411-424 (771 nt) was the least conserved. A phylogenetic tree constructed using the sequences of all the CLCuD causing begomoviruses, corresponding to the least conserved region showed that they form two distinct clusters.

Osteosarcoma occurring in osteogenesis imperfecta tarda.

The combination of osteogenesis imperfecta (OI) and osteosarcoma is rare, as reflected by the fact that there are only eight proven cases in the published English literature. We present here another case, one that was treated by modern oncological techniques and major limb salvage surgery in the form of distal femur endoprosthesis initially and later a total femur replacement. The patient is the only one of the series to have had major limb salvage and is the only--and longest--surviving patient (more than 6 years), thus disproving the probability that this combination of disorders is particularly lethal. We present the case history, review the literature, and look at the cases presented in the past. We contend that adequate awareness, early diagnosis, and prompt oncological management results in better prognosis for osteosarcoma occurring in OI.

Evidence for recombination among the tomato leaf curl virus strains/species from Bangalore, India.

Tomato leaf curl virus (ToLCV) belongs to the Begomovirus genus of the family Geminiviridae. These viruses have circular single stranded DNA molecules as their genome encapsidated in icosahedral geminate particles. Generally the Begomoviruses are bipartite with respect to their genomic composition. ToLCV from South India is unique in that only DNA A component has been isolated and sequenced thus far and there is no evidence for the presence of DNA B component. In this communication we report the genomic sequences of DNA A component of two strains of Tomato leaf curl Bangalore virus (ToLCBV), one from Bangalore, ToLCBV [Ban 5] and the other from Kolar (70 kms from Bangalore), ToLCBV [Kolar]. We have examined the possibility of recombination between strains/species that co-exist within the same geographical location. A novel method has been used to analyze the variation of ToLCV sequences reported from Bangalore and to assess the frequency and importance of recombinational events among the strains/species existing in Bangalore. The results indicate that there are potential sites of recombination in AV1, AV2, AC1 and intergenic regions of the viral genome and this accounts for the observed variability in these strains/species.

Surface aneurysmal bone cysts: a pictorial review.

The aim of this article is to present the imaging features of surface aneurysmal bone cysts (ABCs). Twenty-three surface ABCs were identified from of a series of 144 histologically proven ABCs treated in our unit over the past 20 years. The surface ABCs showed a high female preponderance with a predilection for the forearm bones, tibia and femur. With the use of radiographs in all cases and CT and MR imaging in 18 cases it was possible to subdivide the series into subperiosteal (11 cases), cortical (8 cases) and mixed (4 cases) categories. The imaging features distinguishing the various categories are illustrated and the differential diagnosis is discussed.

Recurrent episodic foot-drop following surgery to the thigh.

Subject. We present the case history of a 47-year-old lady who, 10 months following excision of a soft tissue sarcoma from the left thigh, was struck with recurrent episodes of foot drop.Discussion. The curious phenomenon of recurrent foot drop was found to be secondary to pressure symptoms from a tense seroma of the thigh. She underwent surgical excision of the sac and had immediate and complete relief of symptoms.