Successful outcome of pregnancy in a case of Guillain Barre syndrome-report of a rare case and review of literature

Guillain Barre syndrome (GBS) is a rare autoimmune neurological disorder that has been reported to carry a high maternal risk and maternal mortality risk of >10% if occurred during pregnancy. It is characterized by acute onset of symmetrical ascending paralysis with or without respiratory depression and autonomic dysfunction secondary to gastrointestinal or respiratory infection. This is case report of 30 years old multigravida who presented at 19 weeks period of gestation with sudden onset back pain and bilateral lower limb weakness that progressed to involve bilateral upper limbs with respiratory insufficiency.  Based on clinical presentation and relevant investigations like serum electrolyte, arterial blood gas analysis and nerve conduction studies, provisional diagnosis of GBS was made. In collaboration with the physician, she was managed with ventilator support for 12 days, intravenous immunoglobulin and supportive therapy. This was followed by complete and rapid recovery as she was extubated on 12th day and discharged on day 16. Patient was followed by strict maternal and fetal surveillance. She successfully delivered a healthy boy at 38 weeks of period of gestation by caesarean section done in view of meconium-stained liquor grade 3 in early labour and she was discharged on day 3 of LSCS.

Staining susceptibility of dental composite resins with various nano-filler technologies

Background: Discoloration of dental composite restoration is a common problem that usually results in refurbishing or replacement or even removal of the restoration. Objective: The purpose of this study was to evaluate the color stability of polished composite resin material with different filler technologies. Methodology: Three composites were studied; Filtek™ Z350 XT (3M, ESPE, St. Paul, USA) [Group-I] that has nano-cluster filler particles, Brilliant EverGlow™ (Coltene/Whaledent® AG, Altstatten, Switzerland) [Group-II] which consists of submicron barium glass fillers and pre-polymerized fillers and Ceram.X® Sphere TEC™ (Dentsply, Konstanz, Germany) [Group-III] with advanced granulated filler technology composite. Twenty standardized composite discs were prepared with each composite resin, and it was polished with Sof-Lex disks (3M, ESPE, St. Paul, USA). The baseline color was then recorded using a spectrophotometer (X-Rite PANTONE® iPro-2, Michigan). Eight samples from each group were then subdivided and immersed into freshly prepared solutions of turmeric, coffee, and four samples into distilled water for a total period of 3 hours/day for 30 days. Following this, the color was again recorded. Statistical analysis: The change in color (ΔE) was calculated, and the data obtained were subjected to Kruskal Wallis and Mann Whitney test. Results: A significant difference was seen between the staining characteristics of Group-III and Group-I (p<0.05). The mean color change in the values was highest in Ceram.X that was clinically unacceptable (ΔE>3.3). Conclusion: Though all composites revealed color changes after their immersion into the staining solutions, the amount of stain varied based on their constituents and filler characteristics

Revisiting Folger's pouch in double-chambered right ventricle

Folger's pouch is a right ventricular outflow pouch arising from the distal low-pressure chamber in double-chambered right ventricle. It is rarely described on echocardiogram due to difficult visualization and lack of knowledge of its existence. Retrospective assessment of echocardiogram after an angiocardiographic evaluation demonstrates the pouch in a modified high parasternal view

Eisenmenger's syndrome: Management and workup for heart–lung transplant

Heart–lung transplant remains the final option for patients with congenital heart disease (CHD) and irreversible pulmonary vascular obstructive disease (PVOD) when the patients are symptomatic despite optimal medical management. This panel discussion, held during cardiovascular disease convergence 2018, takes us through the journey of an 18-year-old patient suffering from a complex cyanotic CHD with irreversible PVOD and severe ventricular dysfunction. Pertinent management issues concerning pharmacotherapy and supportive care are discussed. Finally, workup and listing criteria for heart–lung transplant are discussed. The patient still awaits heart–lung transplant

Peripheral Cemento-Ossifying Fibroma with Uncommon Clinical Presentation: A Case Report

Peripheral cemento-ossifying fibroma (PCOF) is a reactive gingival over growth, occurring frequently in the maxillary anterior region of teenage and young females. Peripheral cemento-ossifying fibroma (PCOF) is supposed to be originating from periosteum and/or periodontal ligament. A large number of factors have been implicated in the pathogenesis of PCOF, which includes trauma, local irritation, calculus and hormonal disturbances. The definitive diagnosis of PCOF is based upon its clinical, radiological and histological features. Because of the high recurrence rate (8-20%) of PCOF, a close post-operative follow-up is required. Herewith, we are presenting a case of PCOF in 24-year old female patient at an uncommon location.El fibroma cemento-osificante periférico (PCOF, por sus siglas en inglés) es un crecimiento gingival reactivo, que se produce con frecuencia en la región anterior del maxilar en adolescentes y mujeres jóvenes. Se supone que el fibroma cemento-osificante periférico (PCOF) se origina en el periostio y/o el ligamento periodontal. Una gran cantidad de factores han sido implicados en la patogénesis de PCOF, dentro de las que se incluye trauma, irritación local, cálculo y alteraciones hormonales. El diagnóstico definitivo de PCOF se basa en sus características clínicas, radiológicas e histológicas. Debido a la alta tasa de recurrencia (8-20%) , se requiere un seguimiento post-operatorio estricto. Mediante este artículo presentamos un caso de PCOF en una paciente de 24 años de edad y el manejo teraupético

Isolated agenesis of the right pulmonary veins with pulmonary sequestration

We report two cases of agenesis of the right pulmonary veins (PVs) associated with sequestration of the right lung with systemic to pulmonary collateral. Both the children were referred for evaluation of recurrent lower respiratory tract infections. Transthoracic echocardiographic evaluation showed reversal of flow in the right pulmonary artery (PA) and absent right PVs. Cardiac catheterization confirmed the diagnosis of agenesis of the right PVs. Transcatheter closure of collaterals was performed in view of significant shunt from systemic to PA. Both the patients are asymptomatic on follow-up

ORTHO-ENDO-PERIO: AN INTERPROFESSIONAL CASE REVIEW

The interdisciplinary approach is necessary to enhance the synergy between the three disciplines while improving the treatment outcomes and eliminating the existing barriers. Orthodontic treatment focuses on functional and aesthetic occlusion while endodontic therapy deals with the viability of dental pulp and root resorption, whereas, periodontal therapy aims to achieve healthy attachment of teeth with supporting structures. The orthodontic therapy has been used as an adjunct therapy to facilitate functional occlusion and tissue support, most of the periodontal and endodontic problems can be resolved by the correction of periapical pathology, traumatic injuries, pathological tooth migration, crowding, closure of midline diastema and many more. Need of the hour is to have a cross-disciplinary approach which helps the specialist in diagnosis and treatment planning, with accomplishment of planned treatment and solving any complications related to it. This mini review highlights the relevance of few cases and their systematic approach where orthodontic tooth movement is assisted by endodontic and periodontal therapy contributing to optimize treatment outcome of combined orthodontic-endodontic- periodontal problems

High soluble interleukin-2 receptor values in Indian paediatric & adult controls – Need for population-specific threshold in the diagnosis of haemophagocytic lymphohistiocytosis

Background & objectives: Elevated soluble interleukin-2 receptor (sIL2R) is a diagnostic criterion for haemophagocytic lymphohistiocytosis (HLH). International guidelines propose a 2400 U/ml cut-off or individual laboratory-defined cut-off. However, sIL2R normal values are so far not known in Indians. So, this study was undertaken to measure sIL2R in healthy children and adults to establish age-related reference values. Methods: Healthy controls and cases (participants with persistent fever, organomegaly, cytopenias and biochemical markers of HLH) were prospectively enrolled. Serum sIL2R was measured by double-sandwich enzyme immunoassay in a standardization batch to determine the optimum cut-off value using receiver operator characteristic curve and was subsequently validated. Results: One hundred and forty six age- and sex-matched children (80 controls and 66 suspected HLH cases) and 55 adults (49 controls and 6 suspected HLH cases) were prospectively enrolled. The optimal sIL2R cut-off ≥23 ng/ml was defined as raised sIL2R in the standardization batch. No controls had sIL2R ≥23 ng/ml in the validation batch. In healthy controls, median sIL2R (interquartile range) decreased with increasing age from 9.0 ng/ml (6.6-13.4) below five years of age to 3.2 ng/ml (2.8-5.1) in adults. Proposed upper limit of normal value for sIL2R is 17.4 ng/ml in less than five year, 12.2 ng/ml in 5-9 yr, 6.7 ng/ml in 10-17 yr and 5.2 ng/ml in ≥18 yr. sIL2R accuracy to diagnose HLH marginally improved with age-appropriate cut-off. Interpretation & conclusions: Paediatric controls in India showed higher sIL2R levels than most studies conducted in other countries, except for some reports in Chinese and Russian populations. Age-appropriate reference values of sIL2R in a specific population may be considered to determine elevated sIL2R as a marker of HLH