Role of transesophageal echocardiography: a rare case of acute left atrial free wall dissection.

Transesophageal echocardiography (TEE) has been used routinely in the diagnosis and follow-up of cardiac cases. Left atrial dissection (LAd), an exceedingly rare complication of cardiac surgery, is most commonly associated with mitral valve surgery. A case of LAd is presented, and the pathology was accurately defined and immediately diagnosed using intraoperative TEE. This case highlights the importance of prompt diagnosis of LAd using intraoperative TEE, and a second cardiac surgery was avoided.

Modulating effects of hesperidin on key carbohydrate-metabolizing enzymes, lipid profile, and membrane-bound adenosine triphosphatases against 7,12-dimethylbenz(a)anthracene-induced breast carcinogenesis.

The aim of this study was to document the effect of hesperidin on the key enzyme activities of carbohydrate metabolism, lipid profile, and membrane-bound adenosine triphosphatases (ATPases) during 7,12-dimethylbenz(a)anthracene (DMBA)-induced breast carcinogenesis. Hesperidin has been reported to have multiple biological properties. Breast cancer was induced by single dose of DMBA (20 mg/kg body weight (bw)). The results revealed that there was a significant increase in the activities of hexokinase, phosphoglucoisomerase, and aldolase and a concomitant decrease in the activities of glucose-6-phosphatase and fructose-1,6-diphosphatase in cancer-induced animals. The activities of ATPases were found to be decreased both in erythrocyte membrane and in the liver of mammary cancer-bearing animals. The lipid profiles such as total cholesterol, free cholesterol, phospholipids, triglycerides, and free fatty acids significantly increased and in contrast the ester cholesterol in plasma was found to be decreased, whereas it was found to be elevated in the liver of cancer-bearing groups. The altered levels of the above-mentioned biochemical parameters in cancer-bearing animals were significantly ameliorated by the administration of hesperidin at the dosage of 30 mg/kg bw for 45 days. The histopathological analysis of breast and liver tissues were well supported the modulatory property of hesperidin, and this might be associated with normalizing the gluconeogenesis process, stabilization of cell membranes, and modulation of lipid biosynthesis.

C-arm fluoroscopy: a reliable modality for retrieval of foreign bodies in the maxillofacial region.

The anatomic complexity of the maxillofacial region makes the retrieval of foreign bodies a daunting task for the maxillofacial Surgeon. Moreover the inability of 2-dimensional imaging to precisely locate foreign bodies makes it challenging. The anatomic proximity of critical structures and esthetic considerations limits the access and thus poses a greater challenge for the surgeon in cases of foreign body retrieval. Hereby we propose a simple technique and a case report to support, the retrieval of small (<5 mm greatest dimension) objects from the maxillofacial region. The present technique uses a 2 dimensional mobile C arm Fluoroscopy and a needle triangulation method to precisely locate a loosened miniplate screw in the mandibular angle region.

Peripheral squamous odontogenic tumor.

A case of peripheral squamous odontogenic tumor is described in a 60-year-old female who presented with a sessile growth in the right posterior mandible. Radiographic examination revealed no evidence of a central lesion in bone. With the characteristic histopathological picture of benign-appearing islands of squamous epithelium scattered randomly against a background of mature fibrous connective tissue, the tumor was diagnosed as peripheral squamous odontogenic tumor (PSOT). The epithelial islands showed peripheral cuboidal or flattened cells, microcyst formation, individual cell keratinization, and keratin pearl formation.

Iron and intestinal immunity.

PURPOSE OF REVIEW: Recent advances in the study of iron metabolism have led to a better understanding of the molecular basis for the interactions between iron and the inflammatory response. We will review this new information in the context of the gastrointestinal tract. RECENT FINDINGS: The effects of iron on microbial enteropathogens are well known. Recent work has demonstrated that iron also has potentially important effects on the intestinal microbiota. On the host side, hepcidin, a key regulator of mammalian iron metabolism, has emerged as an important mediator of the cross-talk between iron homeostasis and inflammation. Hepcidin-dependent changes in iron flux can influence the expression of inflammatory cytokines, and conversely, inflammatory cytokines can induce hepcidin expression and alter iron homeostasis. Hepcidin levels have been found to be elevated in some studies of inflammatory bowel disease, while manipulating hepcidin expression in animal models of this condition has beneficial effects on both inflammation and dysregulated iron metabolism. SUMMARY: The information on iron metabolism that has become available in recent years has shed new light on the pathogenesis of inflammatory diseases of the gastrointestinal tract, and is also starting to suggest new approaches to treating such diseases.

Incidental discovery of odontogenic keratocyst in an edentulous patient: importance of routine pre-prosthetic radiographic evaluation.

The most common modality of treatment for completely edentulous patients are conventional removable complete dentures. The protocol for fabrication of complete denture would involve a thorough clinical examination and radiographic investigation. As a routine, unless clinical findings suggest presence of remnant tooth structures, or the patient presents himself with symptoms, the radiographic investigations are overlooked. This case report presents one such situation wherein routine radiographic evaluation of a clinically asymptomatic edentulous individual prior to prosthetic rehabilitation revealed the presence of an odontogenic keratocyst of anterior maxilla substantiating the importance of such routine pre-prosthetic radiographic investigations.

Maxillary Growth Encircling the Central Incisor Crown.

During osteogenesis, mesenchymal tissues function to form fibrous matrix which changes into bone by ossification. In rare instances, fibrous matrix persists in which foci of immature bone is evident resulting in progressive enlargement. Such conditions are commonly benign in nature but few are anatomically benign and clinically destructive. Though recurrence and residual defects following surgical treatment are the challenging complications, fatal consequences are infrequent. We report a juvenile case of ossifying fibroma with an aim to highlight its clinical course and salient criteria to differentiate this entity from the common variants.

Effects of enteropathogenic bacteria & lactobacilli on chemokine secretion & Toll like receptor gene expression in two human colonic epithelial cell lines.

BACKGROUND & OBJECTIVE: The intestinal epithelium is part of the innate immune system responding to contact with pathogenic or commensal bacteria. The objective of this study was to compare innate responses of intestinal epithelial cell lines to pathogenic bacteria and to lactobacilli. METHODS: Two human intestinal epithelial cell lines, HT29 (enterocyte-like) and T84 (crypt-like), were exposed to pathogenic bacteria representative of non invasive (Vibrio cholerae O1 and O139), adherent (enterohaemorrhagic Escherichia coli, EHEC) or invasive (Salmonella Typhimurium and Shigella flexneri) phenotypes and to non pathogenic Lactobacillus rhamnosus GG or Lactobacillus plantarum. Interleukin-8 (IL-8) was measured in culture supernatant by ELISA, while mRNA from cells was subjected to quantitative reverse transcriptase PCR for several other chemokines (CXCL1, CCL5 and CXCL5) and for Toll-like receptors (TLR) 2, 4, 5 and 9. RESULTS: V. cholerae, S. Typhimurium, S. flexneri and EHEC induced IL-8 secretion from epithelial cells into the medium. Salmonella, Shigella and EHEC, but not V. cholerae, significantly increased mRNA expression of CXCL1. None of the pathogens induced CCL5 or CXCL5. Salmonella and Vibrio significantly increased TLR4 expression, while Vibrio and EHEC decreased TLR5 expression. EHEC also decreased TLR9 expression. Lactobacilli attenuated the IL-8 response of the cell lines to V. cholerae, Salmonella, and EHEC but did not significantly change the IL-8 response to Shigella. INTERPRETATION & CONCLUSION: Distinct patterns of epithelial cell chemokine responses were induced by the bacterial pathogens studied and these were modulated by commensal lactobacilli. Alterations in TLR expression by these pathogens are likely to be important in pathogenesis.

Effect of Vibrio cholerae on chemokine gene expression in HT29 cells and its modulation by Lactobacillus GG.

Epithelial cells participate in the innate immune response to pathogenic bacteria by elaborating chemokines. This study examined the effect of Vibrio cholerae and Lactobacillus rhamnosus GG on inflammatory chemokine gene expression in the HT29 human intestinal epithelial cell line. HT29 cells were exposed to V. cholerae 0139, Lactobacillus or both for 2 h and cultured further thereafter for 4 h. RNA was extracted from the cells and expression of genes for chemokines and related molecules was quantitated by real time PCR using a pathway-focused PCR array. TLR4 was silenced using shRNA and output of interleukin-8 (IL-8) into the media quantitated with and without V. cholerae exposure. NFkappaB and p38 MAP kinase activation were determined by immunoblotting for IkappaBalpha and phosphorylated p38. Vibrio cholerae significantly upregulated gene expression for the neutrophil chemoattractant CXCL chemokines, IL-8, CXCL and CXCL in HT29 cells, while downregulating the expression of macrophage-attracting C-C chemokines. TLR4 silencing did not reduce IL-8 output from HT29 cells in response to V. cholerae. IkappaBalpha degradation was noted in the HT29 cells soon after exposure to V. cholerae and this recovered over time after removal of bacteria. p38 MAP kinase activation was not noted. Vibrio cholerae upregulated the expression of neutrophil attractant chemokines, most prominently IL-8, in HT29 cells, but downregulated macrophage-attracting chemokines. Probiotic lactobacilli modulated the IL-8, but not the other chemokine gene changes, in response to V. cholerae.

Two step purification of Acinetobacter sp. lipase and its evaluation as a detergent additive at low temperatures.

Acinetobacter sp. lipase was purified to homogeneity by a two-step process. The crude enzyme (along with biomass) was subjected to partial purification by aqueous two phase system (ATPS), avoiding centrifugation and filtration steps. Conditions for lipase partitioning by ATPS were optimized by response surface methodology (RSM) and a combination of 29.45% polyethylene glycol 8000, 15.5% phosphate, and a pH of 7.0 resulted in an optimal partition coefficient. Partially pure lipase was further purified by a modified batch process using Octyl Sepharose CL-4B in a vacuum filtration apparatus. This two-step process resulted in a purified lipase with a yield of 74.6% having a specific activity of 88.8 U/mg of protein and a purification fold of 14.92. The homogeneity of the lipase preparation obtained by the purification process was confirmed by reversed phase high performance liquid chromatography profile. The molecular weight of the purified lipase was found to be around 32 kDa as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The purified lipase exhibited pH and temperature optima of 8.5 and 37 degrees C, respectively. The lipase was active at low temperatures and it retained 86.8% activity at 10 degrees C. It also displayed other features such as stability over a broad range of pH (3.0-9.0) as well as stability in the presence of hydrogen peroxide and commercial detergents. Based on these characteristics, the potential of this lipase as an additive in laundry detergent formulation was evaluated under low temperature wash conditions. The results indicated that Acinetobacter sp. lipase increased the washing efficiency of the detergent Nirma by 21-24% at 15 degrees C-20 degrees C, respectively.

Review of maxillofacial injuries in Chennai, India: a study of 2748 cases.

We reviewed the medical records of 2748 patients treated for maxillofacial injuries at Sri Ramachandra Medical and Dental College and Hospital between January 1999 and December 2005. 1332 (42%) had soft tissue injuries, 1176 (37%) had mid face fractures, and 512 (16%) had mandibular fractures. Most patients with midface fractures had fractures of the zygomaticomaxillary region 422 (36%), while fractures of the parasymphyseal region were more common in the mandible 156 (31%). Most patients were in the 21-30 year-old age group, and the male:female ratio was 3.7:1. Road crashes, particularly involving motorcycles, accounted for 1710 (62%), with a high prevalence during the month of September and on Saturdays.

Efficacy of lipase from Aspergillus niger as an additive in detergent formulations: a statistical approach.

The efficacy of lipase from Aspergillus niger MTCC 2594 as an additive in laundry detergent formulations was assessed using response surface methodology (RSM). A five-level four-factorial central composite design was chosen to explain the washing protocol with four critical factors, viz. detergent concentration, lipase concentration, buffer pH and washing temperature. The model suggested that all the factors chosen had a significant impact on oil removal and the optimal conditions for the removal of olive oil from cotton fabric were 1.0% detergent, 75 U of lipase, buffer pH of 9.5 and washing temperature of 25 degrees C. Under optimal conditions, the removal of olive oil from cotton fabric was 33 and 17.1% at 25 and 49 degrees C, respectively, in the presence of lipase over treatment with detergent alone. Hence, lipase from A. niger could be effectively used as an additive in detergent formulation for the removal of triglyceride soil both in cold and warm wash conditions.

Occupational malaria and health risk among select occupational health care employee groups in an urban hospital at Tirupati, A.P.

Epidemiological studies on occupational environments are very meagre in the developing countries like India. For this reason an attempt was made in the present investigation to see the occupational risk of malaria among health care workers of Sri Venkateswara Ramnarayan Ruia Government General Hospital (SVRRGGH), Tirupati, Andhra Pradesh. The cohort studies revealed association between exposure to occupational (hospital) environment and malaria among hospital staff. Retrospective cohort studies were made. 1,454 subjects namely hospital staff exposed to occupational environment included civil assistant surgeons and physicians, the students of medicine, the students of nursing, permanent nursing staff and the class IV employees (class IV included janitorial, male nursing orderlies, female nursing orderlies, attenders, laundry workers and the rest). Retrospective epidemiological studies were carried out for four years on the cohorts and the hospital staff. The data showed statistically significant relative risk and attributable risk for malaria. Physicians and civil assistant surgeons showed no incidence of malaria. The relative risk for malaria in the class IV employees was 1.27, 0, 5.8 and 2.9 for the years 1995-98. The students of nursing showed 4.2, 2.42, 3.3 and 0 relative risk for malaria, whereas the students of medicine showed 2, 2, 2 and 1.6 for the years 1995 to 1998. The attributable risk was ranged from 21.76-82.70, 58.75-76.17, 50-80 for the class IV employees, the students of nursing and the students of medicine retrospectively. These results provide an evidence for an association between occupational environment and malaria for the hospital staff and is more prevalent among certain groups of the hospital staff.

Mechanisms of fatigue in normal intercostal muscle and muscle from patients with myasthenia gravis.

Fatigue mechanisms in normal intercostal muscle and muscle from patients with myasthenia gravis (MG) were evaluated by monitoring the compound muscle action potential (CMAP) and tetanic tension responses to repetitive nerve or muscle stimulation in vitro. When fatigue was induced by nerve stimulation at 30 Hz for 0.5 s every 2.5 s, about half of the original tension decreased after 30 min in normal muscle and 5 min in MG muscle. Analysis of the changes in area of CMAPs and tension indicated that impairment of neuromuscular transmission, muscle membrane excitation, and excitation-contraction (E-C) coupling and contractility accounted for 40%, 29%, and 31% of fatigue in normal muscle, and 83%, 0%, and 17% of fatigue in MG muscle. When fatigue was induced by muscle stimulation at 30 Hz, tension declined by a quarter after 30 min in normal muscle, but by a half after 17 min in MG muscle. Impairment of muscle membrane excitation and E-C coupling and contractility accounted for 58% and 42% of fatigue in normal muscle, and 22% and 78% of fatigue in MG muscle. Thus, fatigue of normal muscle is caused by impairment of at least four processes, and enhanced fatigue of MG muscle is caused by greater impairment of neuromuscular transmission, E-C coupling, and contractility.

Peripheral mechanisms of fatigue in muscles of normal and dystrophic mice.

We evaluated the contribution of different processes to fatigue of normal and dystrophic mouse muscles using an in vitro electromyography chamber. Fatigue was induced by repetitive nerve stimulation at 30 Hz for 0.5 s, every 2.5 s until tension decreased by about 50%. We monitored the compound nerve action potential (AP), compound muscle AP, and isometric tension responses to nerve stimulation, and compound muscle AP and tension responses to direct muscle stimulation. In normal mice, about 50% reduction in nerve-evoked tension occurred by 2.4 min in extensor digitorum longus (EDL), 4.8 min in diaphragm, and 9 min in soleus. Analysis of the responses revealed that the fatigue was caused by failure of more than one process in all muscles, and failure of nerve conduction did not contribute to fatigue in any muscle. Failure of neuromuscular transmission, muscle membrane excitation, and excitation-contraction (E-C) coupling and contractility accounted for 55, 45, and 0%, respectively, of the fatigue in EDL, for 21, 74, and 5% of the fatigue in diaphragm, and for 2, 54, and 44% of the fatigue in soleus. In dystrophic mice, while about 50% reduction in nerve-evoked tension occurred by 8.1 min in EDL and 5.6 min in diaphragm, only 29% reduction in tension occurred by 80 min in soleus. Failure of neuromuscular transmission, muscle membrane excitation, E-C coupling and contractility accounted for 22, 63 and 15% of the fatigue in EDL, for 21, 79, and 0% of the fatigue in diaphragm, and for 15, 59, and 26% of the fatigue in soleus. The proportion of slow-twitch oxidative fibers was more than normal in dystrophic EDL, but the same as normal in dystrophic diaphragm and soleus. The slower onset of fatigue was attributable to lesser failure of neuromuscular transmission in dystrophic EDL, and to lesser failure of E-C coupling and contractility in dystrophic soleus.

Responses of intercostal muscle biopsies from normal subjects and patients with myasthenia gravis.

In order to evaluate the mechanisms of weakness in muscles of patients with myasthenia gravis (MG), intercostal muscle biopsies were obtained from 9 normal subjects and 6 MG patients, and the compound muscle action potential (AP) and tension responses to nerve and muscle stimulation, and contracture responses on exposure to caffeine, were monitored in vitro. In normal muscle, on stimulation of the nerve or muscle at 30 to 100 Hz, the AP responses showed decrement in amplitude, one-third of which was attributable to failure of neuromuscular transmission and two-thirds to failure of muscle membrane excitation. On stimulation at 1 to 5 Hz, the AP responses showed very little decrement, while the contractile responses showed significant fade in tension, due to failure of E-C coupling or contractility. In muscle from patients with generalized MG, stimulation of the nerve at all frequencies (1 to 100 Hz) caused much greater decrement in APs and fade in tension responses than in normal muscle, due mainly to failure of neuromuscular transmission. However, at 100 Hz, 40% of the decrement in APs was due to failure of muscle membrane excitation, and at 1 to 5 Hz, 40% of the fade in tension was due to failure of E-C coupling or contractility, as in normal muscle. On direct stimulation the contraction and half-relaxation times were slower and the tetanic tension was smaller than in normal muscle, especially in the MG patient with thymoma. Caffeine-induced contractures were smaller in MG muscle than in normal muscle. These results indicate that while the weakness of MG muscle is due mainly to failure of neuromuscular transmission, it is also partly due to reduced E-C coupling or contractility.

Effect of Cleistanthus collinus leaf extract on neuromuscular function of the isolated mouse phrenic nerve-diaphragm.

Cleistanthus collinus is a toxic plant whose leaves have been used for homicidal or suicidal purposes. Since the toxic effects include muscle cramps and weakness, the effect of the leaf extract on the electrical and mechanical responses to nerve and muscle stimulation was studied in the isolated phrenic nerve-diaphragm preparation of the mouse. Following a 1 hr exposure to 0.015% leaf extract, the response of the compound nerve action potential to supramaximal nerve stimulation was reduced by 38%. The compound muscle action potential was reduced by 97%, and isometric tension by 99%. In response to direct muscle stimulation the compound muscle action potential and isometric tension were reduced by 38%. There was only an 11% reduction in resting membrane potential, but a 51% reduction in the amplitude of miniature endplate potentials. Endplate potentials could be evoked by nerve stimulation without prior treatment of the muscle with curare or a high concentration of magnesium. These studies indicate that the leaf extract markedly inhibits muscle contraction by reducing excitability of the nerve and muscle membranes, and by blocking neuromuscular transmission, without affecting excitation-contraction coupling or contractility of the muscle fibers.

Colorimetric determination of dimethoate or omethoate.

A simple, sensitive and rapid colorimetric method is described for determining dimethoate [O,O-dimethyl-S-(N-methylcarbanoylmethyl)phosphorodithioate] and omethoate by an enzymatic method using pig liver acetone powder as enzyme source and p-nitrobenzenediazonium fluoroborate as the chromogenic reagent. This colorimetric method is more sensitive than non-enzymatic methods. Inhibition can be detected at ng levels and amounts ranging from 50 to 1000 ng of omethoate and from 1 to 10 mug of dimethoate can be estimated.