Anti-salivary gland protein 1 antibodies in two patients with Sjogren’s syndrome: two case reports

INTRODUCTION: Current diagnostic criteria for Sjogren’s syndrome developed by the American College of Rheumatology include the presence of antinuclear antibodies, rheumatoid factor, anti-Ro or anti-La autoantibodies. The purpose of this report is to describe two patients with biopsy-proven Sjogren’s syndrome lacking these autoantibodies but identified by antibodies to salivary gland protein 1. Diagnosis was delayed until salivary gland tumors developed in these patients because of the lack of the classic autoantibodies. This report emphasizes the existence of patients with primary Sjogren’s syndrome who lack autoantibodies anti-Ro or anti-La and may therefore be misdiagnosed. Antibodies to salivary gland protein 1 identify some of these patients. CASE PRESENTATION: Two patients are described and were seen in the autoimmune disease clinics of the State University of New York (SUNY) at the Buffalo School of Medicine. In both patients, chronic dry mouth and dry eye had been dismissed as idiopathic because test results for autoantibodies anti-Ro and anti-La were negative. Both patients had swelling of major salivary glands that prompted biopsies. Biopsies of major salivary glands from both cases demonstrated salivary gland tumors and existence of inflammation consistent with Sjogren’s syndrome. Serologic testing revealed antibodies to salivary gland protein 1. CONCLUSIONS: Patients presenting with classic clinical symptoms of dry mouth and eyes do not always show the current serologic markers of Sjogren’s syndrome, anti-Ro and anti-La. In these cases, investigation for antibodies to salivary gland protein 1 is of importance to make the diagnosis of Sjogren’s syndrome. Early diagnosis of Sjogren’s syndrome is necessary for improved management as well as for vigilance regarding potential complications, such as salivary gland tumors as were seen in the described cases

Mitochondrial myopathy presenting as fibromyalgia: a case report

<p>Abstract</p> <p>Introduction</p> <p>To the best of our knowledge, we describe for the first time the case of a woman who met the diagnostic criteria for fibromyalgia, did not respond to therapy for that disorder, and was subsequently diagnosed by biochemical and genetic studies with a mitochondrial myopathy. Treatment of the mitochondrial myopathy resulted in resolution of symptoms. This case demonstrates that mitochondrial myopathy may present in an adult with a symptom complex consistent with fibromyalgia.</p> <p>Case presentation</p> <p>Our patient was a 41-year-old Caucasian woman with symptoms of fatigue, exercise intolerance, headache, and multiple trigger points. Treatment for fibromyalgia with a wide spectrum of medications including non-steroidal anti-inflammatory drugs, antidepressants, gabapentin and pregabalin had no impact on her symptoms. A six-minute walk study demonstrated an elevated lactic acid level (5 mmol/L; normal < 2 mmol/L). Biochemical and genetic studies from a muscle biopsy revealed a mitochondrial myopathy. Our patient was started on a compound of coenzyme Q10 (ubiquinone) 200 mg, creatine 1000 mg, carnitine 200 mg and folic acid 1 mg to be taken four times a day. She gradually showed significant improvement in her symptoms over a course of several months.</p> <p>Conclusions</p> <p>This case demonstrates that adults diagnosed with fibromyalgia may have their symptom complex related to an adult onset mitochondrial myopathy. This is an important finding since treatment of mitochondrial myopathy resulted in resolution of symptoms.</p

Metabolic myopathy presenting with polyarteritis nodosa: a case report

<p>Abstract</p> <p>Introduction</p> <p>To the best of our knowledge, we describe for the first time a patient in whom an unusual metabolic myopathy was identified after failure to respond to curative therapy for a systemic vasculitis, polyarteritis nodosa. We hope this report will heighten awareness of common metabolic myopathies that may present later in life. It also speculates on the potential relationship between metabolic myopathy and systemic vasculitis.</p> <p>Case presentation</p> <p>A 78-year-old African-American woman with a two-year history of progressive fatigue and exercise intolerance presented to our facility with new skin lesions and profound muscle weakness. Skin and muscle biopsies demonstrated a medium-sized artery vasculitis consistent with polyarteritis nodosa. Biochemical studies of the muscle revealed diminished cytochrome C oxidase activity (0.78 μmol/minute/g tissue; normal range 1.03 to 3.83 μmol/minute/g tissue), elevated acid maltase activity (23.39 μmol/minute/g tissue; normal range 1.74 to 9.98 μmol/minute/g tissue) and elevated neutral maltase activity (35.89 μmol/minute/g tissue; normal range 4.35 to 16.03 μmol/minute/g tissue). Treatment for polyarteritis nodosa with prednisone and cyclophosphamide resulted in minimal symptomatic improvement. Additional management with a diet low in complex carbohydrates and ubiquinone, creatine, carnitine, folic acid, α-lipoic acid and ribose resulted in dramatic clinical improvement.</p> <p>Conclusions</p> <p>Our patient's initial symptoms of fatigue, exercise intolerance and progressive weakness were likely related to her complex metabolic myopathy involving both the mitochondrial respiratory chain and glycogen storage pathways. Management of our patient required treatment of both the polyarteritis nodosa as well as metabolic myopathy. Metabolic myopathies are common and should be considered in any patient with exercise intolerance. Metabolic myopathies may complicate the management of various disease states.</p

Progression-free survival estimation of docetaxel-based second-line treatment for advanced non-small cell lung cancer: a pooled analysis from 18 randomized control trials

BackgroundLung cancer is the foremost cause of cancer-related death globally, with non-small cell lung cancer (NSCLC) accounting for 85–90% of cases. Targeted therapy is the most essential therapeutic option for NSCLC, other common treatments include radiation therapy, surgery, chemotherapy, and immunotherapy.ObjectiveOur study objective was to estimate whether progression-free survival (PFS) is an outcome of NSCLC extracted from 18 randomized control trials (RCTs) with docetaxel as experimental group and antineoplastic agent, kinase inhibitor, and monoclonal antibodies as a control group.MethodsWe selected relevant studies published between 2011 and 2022 using Google Scholar, PubMed, Scopus, Science Direct, and Cochrane Library. Advanced NSCLC, chemotherapy, RCT, docetaxel, and second-line treatment were the terms included in the search. A total of 9738 patients were evaluated from the 18 identified studies. We used the meta package of R Studio to perform the meta-analysis. Graphical funnel plots were used to evaluate publication bias visually.ResultsPatients who underwent docetaxel-based therapy had a considerably longer PFS than those who got antineoplastic agents, kinase inhibitors, or monoclonal antibodies-based treatment. Patients in the standard treatment arm had a slightly longer PFS than those in the experimental therapy arm in the overall meta-analysis.ConclusionDocetaxel outperformed monoclonal antibodies, antineoplastic agents, and kinase inhibitors in the second-line therapy of advanced NSCLC since PFS was extensively utilized

Eulophia epidendraea (J. Koenig ex Retz.) C.E.C. Fisch. and Thelasis pygmaea (Griff.) Lindl. (Orchidaceae) - new additions to the flora of Karnataka, India

Eulophia epidendraea (J.Koenig ex Retz.) C.E.C.Fisch. and Thelasis pygmaea (Griff.) Lindl. (Orchidaceae) are reported here as new records to the flora of Karnataka from Savanadurga of Bangalore Rural district and Sringeri of Chikmagalur District, respectively. A detailed description, photograph and relevant notes are provided for easy identification of these two species. </div

Central giant cell granuloma in a 4-year-old female child

Central giant cell granulomas (CGCG) are reddish lesions of gingiva that account for an important number of disorders frequently diagnosed in the regular dental practice. Although the majority of the lesions are nonaggressive, asymptomatic, and slow-growing, about 30% show an aggressive, progressively destructive behavior, and a tendency to recur. We present a case of aggressive CGCG of the maxilla in a 4-year-old female child managed by surgical excision. To minimize the possible cost of esthetic, functional, and psychological problems, mainly in young patients, CGCG should be diagnosed and managed at the earliest

Histopathology of Banana Infected with Fusarium oxysporum f. sp. cubense (EF Sm.) Synd. & Hans.

Fusarium wilt is a severe disease of banana plants caused by the fungus Fusarium oxysporum f. sp. cubense . The objective of this study was to trace the pathway and colonization in roots and rhizome of the highly susceptible banana cultivar, ‘Nanjangud Rasabale’. We observed that the entry of the fungus into the roots is primarily through the rootlet, progressing upwards to the rhizome and p seudostem. External symptoms of characteristic yellowing of the lower leaf sheath were observed only after 90 days after inoculation though internally the colonization of the fungus had occurred as early as 45 days after inoculation. ongitudinal splitting of the out er leaf bases just above soil level was seen only after 150 days after inoculation. Formation of chlamydospores, microconidia were observed in root and rhizome sections. Macroconidial formation was observed in only preserved root and rhizome samples

Evaluation of facial image scale and Venham picture test used to assess dental anxiety in children

Aim: To evaluate two short term anxiety rating scales, Facial Image Scale (FIS) and Venham Picture Test, (VPT) that have been used to assess anxiety in children before dental treatment. Materials & Method: Fifty two children aged 6-12 years, who visited the Pediatric Dentistry Department for the first time and whose parents/guardians agreed to take part were included in the study. Anxiety of children was measured on both FIS and VPT scales while they were waiting for treatment in the waiting room. Results: A weak correlation was found between the Facial Image Scale (FIS) and the Venham Picture Test(VPT). (r = 0.087, n = 52 ,p> 0.05) however, the mean anxiety ratings of the two scales did not differ significantly. (t=0.660,/΋>0.05). Conclusions: The findings suggested that both the scales are valid means of assessing child dental anxiety in a clinical context

Effect of Nano Nitrogen and Nano Zinc on Soil Fertility and Crop Productivity of Paddy-paddy Cropping System

Field experiments were conducted during rabi and kharif seasons of 2020-21 and 2021-22 at Krishi Vigyana Kendra, Gangavathi, Koppal, Karnataka, India, to study the influence of nano nitrogen and nano zinc on soil fertility and crop productivity of paddy-paddy cropping system.The experiment was laid out in split-split plot design with different levels of nitrogen in main plots, nano nitrogen sprays in sub-plots and nano zinc sprays in sub-sub plots which were replicated thrice. The results of the study indicated that application of 125 per cent RDN along with foliar spray of nitrogen @ 4000 ppm and nano Zn @ 2000 ppm has recorded significantly higher grain yield, straw yield, soil available N, P2O5, K2O, S and Zn during both rabi and kharif season and which was on par with and 100 per cent RDN along with spray of nano nitrogen @ 4000 ppm and nano Zn @ 2000 ppm. Hence for effective management of nano fertilizers in paddy, the application of 100 per cent RDN along with foliar spray of nano N @ 4000 ppm and foliar spray of nano Zn @ 2000 ppm was recommended