Myxoma of mandible – A case report with literature review

The odontogenic myxoma is an infiltrative benign tumor of bone that occurs almost exclusively in the jawbones and comprises 3% to 6% of odontogenic tumors. This neoplasm is mesenchymal and the myxomatous component is gelatinous in nature. Odontogenic epithelium may occur occasionally in the stroma. Although benign the odontogenic myxoma can cause considerable local destruction. An odontogenic myxoma occuring in the anterior mandible of an 18 year old male is reported here with literature review

Ultrasonic synthesis of CeO2@organic dye nanohybrid: environmentally benign rabid electrochemical sensing platform for carcinogenic pollutant in water samples

A novel organic-inorganic nile-blue - CeO2 (CeO2/NB) nanohybrid has been synthesized by environmentally benign ultrasonic irradiation method for the selective determination of the environmental pollutant, carcinogenic hydrazine (HZ) in environmental water samples. Hydrophobic dyes have generally been as redox mediators in electrochemical sensors fabrication due to strong electron transfer capacity and they would allow the oxidation and reduction of the analytes at lower potentials. The CeO2 nanoparticles were initially synthesized by the ultrasonic irradiation of Ce(NO3)2, NH4OH and ethylene glycol mixture for 6 h using probe sonicator (20 kHz, 100 W) followed by calcination. The organic-dye NB was then added and ultrasonicated further 30 min for the formation of CeO2/NB nanohybrid material. Various spectroscopic and microscopic tools such as UV–vis and FT-IR spectroscopy, XRD, SEM and high-solution TEM and surface analysis tool Brunauer-Emmett-Teller (BET) confirm the formation of the nanohybrid. HR-TEM images showed the well-covered CeO2 on NB molecules and the average size of the nanohybrid is ~35 nm. For the fabrication of environmental pollutant electrochemical sensor, the prepared CeO2/NB nanohybrid was drop-casted on the electrode surface and utilized for the determination of HZ. The nanohybrid modified electrode exhibits higher electrocatalytic activity by showing enhanced oxidation current and less positive potential shift towards HZ oxidation than the bare and individual CeO2 and NB modified electrodes. The fabricated sensor with excellent reproducibility, repeatability, long-term storage stability and cyclic stability exhibited the sensational sensitivity (484.86 µA mM−1 cm−2) and specificity in the presence of 50-fold possible interfering agents with the lowest limit of detection of 57 nM (S/N = 3) against HZ. Utilization of the present sensor in environmental samples with excellent recovery proves it practicability in the determination of HZ in real-time application

Immune reconstitution inflammatory syndrome in association with HIV/AIDS and tuberculosis: Views over hidden possibilities

Gut immune components are severely compromised among persons with AIDS, which allows increased translocation of bacterial lipopolysaccharides (LPS) into the systemic circulation. These microbial LPS are reportedly increased in chronically HIV-infected individuals and findings have correlated convincingly with measures of immune activation. Immune reconstitution inflammatory syndrome (IRIS) is an adverse consequence of the restoration of pathogen-specific immune responses in a subset of HIV-infected subjects with underlying latent infections during the initial months of highly active antiretroviral treatment (HAART). Whether IRIS is the result of a response to a high antigen burden, an excessive response by the recovering immune system, exacerbated production of pro-inflammatory cytokines or a lack of immune regulation due to inability to produce regulatory cytokines remains to be determined. We theorize that those who develop IRIS have a high burden of proinflammatory cytokines produced also in response to systemic bacterial LPS that nonspecifically act on latent mycobacterial antigens. We also hypothesize that subjects that do not develop IRIS could have developed either tolerance (anergy) to persistent LPS/tubercle antigens or could have normal FOXP3+ gene and that those with defective FOXP3+ gene or those with enormous plasma LPS could be vulnerable to IRIS. The measure of microbial LPS, anti-LPS antibodies and nonspecific plasma cytokines in subjects on HAART shall predict the role of these components in IRIS

Does CD4+CD25+foxp3+ cell (Treg) and IL-10 profile determine susceptibility to immune reconstitution inflammatory syndrome (IRIS) in HIV disease?

HIV-specific T-lymphocyte responses that underlie IRIS are incomplete and largely remain hypothetical. Of the several mechanisms presented by the host to control host immunological damage, Treg cells are believed to play a critical role. Using the available experimental evidence, it is proposed that enormous synthesis of conventional FoxP3- Th cells (responsive) often renders subjects inherently vulnerable to IRIS, whereas that of natural FoxP3+ Treg cell synthesis predominate among subjects that may not progress to IRIS. We also propose that IRIS non-developers generate precursor T-cells with a high avidity to generate CD4+CD25+FoxP3+ Tregs whereas IRIS developers generate T-cells of intermediate avidity yielding Th0 cells and effector T-cells to mediate the generation of proinflammatory cytokines in response to cell-signaling factors (IL-2, IL-6 etc.). Researchers have shown that IL-10 Tregs (along with TGF-β, a known anti-inflammatory cytokine) limit immune responses against microbial antigens in addition to effectively controlling HIV replication, the prime objective of HAART. Although certain technical limitations are described herein, we advocate measures to test the role of Tregs in IRIS

A strategy to develop disabled infectious single-cycle (DISC) foot and mouth disease virus by 3B3 gene deletion using the infective cDNA copy of the genome

35-42Disabled infectious single-cycle (DISC) virus is in between attenuated and inactivated. When used as a vaccine DISC virus behaves like inactivated virus as it cannot further multiply in the vaccinated individual after one cycle of replication. When infected to permissive cells expressing virus specific protein which has been deleted from viral genome, the virus replicates normally. The development of DISC virus involves the deletion of an open reading frame (ORF) coding for a key protein involved in the viral replication or viral capsid formation. Such virus, when injected in animals, can complete only one round of replication without producing a progeny virus. Here we report similar strategy followed for the production DISC foot and mouth disease virus (FMDV). We have selected 3B3 protein gene that expresses 3 copies of virus specific genome-linked protein needed for virus replication and deleted from the FMDV replicon carrying FMDV serotype Asia 1 backbone and inserted the same into baby hamster kidney 21 (BHK-21) cell genome. Upon transfection of the genetically modified BHK cells with RNA copy of the genetically modified cDNA, replication of the virus started in these cells. The DISC virus so developed can be a potent vaccine candidate for achieving robust and long duration of immune response against FMDV infection in bovine. The approach also took care in the development of serotype specific DISC viruses using single FMDV Asia 1 replicon. Vaccines based on DISC viruses may be superior in terms of immune response as compared to inactivated vaccines

Malaria prevalence in Nias District, North Sumatra Province, Indonesia

BACKGROUND: The Nias district of the North Sumatra Province of Indonesia has long been known to be endemic for malaria. Following the economic crisis at the end of 1998 and the subsequent tsunami and earthquake, in December 2004 and March 2005, respectively, the malaria control programme in the area deteriorated. The present study aims to provide baseline data for the establishment of a suitable malaria control programme in the area and to analyse the frequency distribution of drug resistance alleles associated with resistance to chloroquine and sulphadoxine-pyrimethamine.\ud METHODS: Malariometric and entomology surveys were performed in three subdistricts. Thin and thick blood smears were stained with Giemsa and examined under binocular light microscopy. Blood blots on filter paper were also prepared for isolation of parasite and host DNA to be used for molecular analysis of band 3 (SAO), pfcrt, pfmdr1, dhfr, and dhps. In addition, haemoglobin measurement was performed in the second and third surveys for the subjects less than 10 years old.\ud RESULTS: Results of the three surveys revealed an average slide positivity rate of 8.13%, with a relatively higher rate in certain foci. Host genetic analysis, to identify the Band 3 deletion associated with Southeast Asian Ovalocytosis (SAO), revealed an overall frequency of 1.0% among the 1,484 samples examined. One hundred six Plasmodium falciparum isolates from three sub-districts were successfully analysed. Alleles of the dhfr and dhps genes associated with resistance to sulphadoxine-pyrimethamine, dhfr C59R and S108N, and dhps A437G and K540E, were present at frequencies of 52.2%, 82.5%, 1.18% and 1.18%, respectively. The pfmdr1 alleles N86Y and N1042D, putatively associated with mefloquine resistance, were present at 31.4% and 2%, respectively. All but one sample carried the pfcrt 76T allele associated with chloroquine resistance. Entomologic surveys identified three potential anopheline vectors in the area, Anopheles barbirostris, Anopheles kochi and Anopheles sundaicus.\ud CONCLUSION: The cross sectional surveys in three different sub-districts of Nias District clearly demonstrated the presence of relatively stable endemic foci of malaria in Nias District, North Sumatra Province, Indonesia. Molecular analysis of the malaria parasite isolates collected from this area strongly indicates resistance to chloroquine and a growing threat of resistance to sulphadoxine-pyrimethamine. This situation highlights the need to develop sustainable malaria control measures through regular surveillance and proper antimalarial drug deployment

Predictors of unfavorable responses to therapy in rifampicin-sensitive pulmonary tuberculosis using an integrated approach of radiological presentation and sputum mycobacterial burden

INTRODUCTION: Despite the exalted status of sputum mycobacterial load for gauging pulmonary tuberculosis treatment and progress, Chest X-rays supplement valuable information for taking instantaneous therapeutic decisions, especially during the COVID-19 pandemic. Even though literature on individual parameters is overwhelming, few studies have explored the interaction between radiographic parameters denoting severity with mycobacterial burden signifying infectivity. By using a sophisticated approach of integrating Chest X-ray parameters with sputum mycobacterial characteristics, evaluated at all the three crucial time points of TB treatment namely pre-treatment, end of intensive phase and completion of treatment, utilizing the interactive Cox Proportional Hazards model, we aimed to precisely deduce predictors of unfavorable response to TB treatment. MATERIALS AND METHOD: We extracted de-identified data from well characterized clinical trial cohorts that recruited rifampicin-sensitive Pulmonary TB patients without any comorbidities, taking their first spell of anti-tuberculosis therapy under supervision and meticulous follow up for 24 months post treatment completion, to accurately predict TB outcomes. Radiographic data independently obtained, interpreted by two experienced pulmonologists was collated with demographic details and, sputum smear and culture grades of participants by an independent statistician and analyzed using the Cox Proportional Hazards model, to not only adjust for confounding factors including treatment effect, but also explore the interaction between radiological and bacteriological parameters for better therapeutic application. RESULTS: Of 667 TB patients with data available, cavitation, extent of involvement, lower zone involvement, smear and culture grade at baseline were significant parameters predisposing to an unfavorable TB treatment outcome in the univariate analysis. Reduction in radiological lesions in Chest X-ray by at least 50% at 2 months and 75% at the end of treatment helped in averting unfavorable responses. Smear and Culture conversion at the end of 2 months was highly significant as a predictor (p2 zones, were 3.05 (95% CI: 1.12–8.23) and 1.92 (95% CI: 0.72–5.08) respectively. Patients without cavitation, zonal involvement 2 zones and 3+ smear grade individually and independently forecasted a poorer TB outcome. The interaction model revealed that Zonal involvement confined to 2 zones, without a cavity and smear grade up to 2+, constituting “minimal disease”, had a better prognosis. Radiological clearance >50% along with smear conversion at the end of intensive phase of treatment, observed to be a reasonable alternative to culture conversion in predicting a successful outcome. These parameters may potentially take up key positions as stratification factors for future trials contemplating on shorter TB regimens

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Non-exposed variant of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with a plasmacytoma: A rare case report

Bisphoshonate-related osteonecrosis of the jaw (BRONJ) is an avascular osteo-chemonecrosis of the jaw which results after administration of the group of drugs called as bisphosphonates. Bisphosphonates are given to prevent bone resorption in osteolytic diseases such as Paget′s, osteoporosis, osteogenic carcinoma, and other carcinomas where there could be metastasis and bone resorption. Incidence of BRONJ is reported to be high in western literature and is found to be more after intravenous route compared to oral route of administration. There are various clinical stages of BRONJ as per the American Association of Oral and Maxillofacial Surgeons (AAOMS). Here, we present a rare case of a 60-year-old lady who presented with a complaint of a painless swelling in the alveolus and gingiva in the left maxillary posterior region. This patient was on intravenous Zolendronate for more than 4 years. Thorough examination with detailed investigations revealed BRONJ along with a coexisting second primary tumor, plasmacytoma. Metastasis to distant site is a common feature of malignancy. A metastatic lesion usually occurs within 6 months to 1 year after treatment of a primary lesion. Any fresh neoplasm beyond 1 or 2 years after detection of a primary can be regarded as a second primary tumor. Solitary bone plasmacytoma is a localized form of plasma cell tumor. Diagnosis is based on the presence of the following: Malignant proliferation of plasma cells in biopsy, absence of osteolytic bone lesion, absence of Bence Jones proteins, low concentration of monoclonal proteins, elevated IgG and gamma globulin levels

Prevalence of temporomandibular disorders in Chennai population

Objective: This study aimed to determine the prevalence of temporomandibular disorders (TMDs) in Chennai city population. Materials and Methods: To obtain a representative sample, a house-to-house survey was conducted in three zones of Chennai and a total of 4197 individuals were randomly selected for the study. Among 4197 individuals, 1158 were excluded from the study, based on the exclusion criteria. Finally, a total of 3039 individuals were included in the study population. Results: More than half of the study sample (53.7%) in the present study had one or more clinical signs and symptoms of TMD. Deviation of mandible on mouth opening (42.1%) and clicking sound (38.6%) made up the highest percentage. Females aged 18 years and older reported higher prevalence of TMD signs and symptoms than men. However, these differences were not significant for all signs and symptoms in all age groups. Prevalence of TMD was reported in this study according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) system of classification, and myofacial pain dysfunction syndrome (MPDS) was reported in 0.8% of the population, internal derangement in 38.3%, and osteoarthritis in 14.6% of the population. Conclusion: Our study, in comparison to other prevalence studies, had a higher sample size and was representative of a cross section of the population. The results of this study show that a significant percentage of the population has signs of TMDs and there are chances that they may develop symptoms of TMDs. Further studies are needed for early identification and initiation of preventive measures which could prevent TMDs progressing to advanced stages where management becomes difficult