Palatal Mucormycosis Masquerading as Bacterial and Fungal Osteomyelitis: A Rare Case Report

Mucormycosis is an acute, fulminating, fungal disease that frequently involves oral, cranial, and facial structures. It is an opportunistic fatal infection which occurs in debilitating and immunosuppressive states. This report documents a rare case of localized maxillary mucormycosis in a patient with uncontrolled diabetes, with emphasis on early and prompt diagnosis of the same.

Eagle's syndrome veiling as pain of odontogenic origin: Report of two cases with cone beam computed tomography illustration

Eagle's syndrome, also known as an elongated styloid process, is a condition that may be the source of craniofacial and cervical pain. It is infrequently reported but is probably more common than generally considered. The symptoms related to Eagle's syndrome can be confused with those attributed to a wide variety of facial neuralgia and or oral, dental, and temporomandibular joint diseases. In this paper, there are two cases, which reported to the Department of Oral Medicine, Diagnosis, and Maxillofacial Radiology, with a chief complaint of radiating pain in the preauricular region of the face. After radiographic investigation, these cases are considered as a case of Eagle's syndrome because of increase in the size of the styloid process.

Relationships between misreported energy intake and pregnancy in the pregnancy, infection and nutrition study: new insights from a dynamic energy balance model

OBJECTIVE

Providing effective dietary counselling so that pregnancy weight gain remains within the 2009 Institute of Medicine (IOM) guidelines requires accurate maternal energy intake measures. Current practice is based on self-reported intake that has been demonstrated unreliable. This study applies an objective calculation of energy intake from a validated mathematical model to identify characteristics of individuals more likely to misreport during pregnancy.

METHODS

A validated maternal energy balance equation was used to calculate energy intake from gestational weight gain in 1,368 subjects. The difference between self-reported and model-predicted energy intake was tested for demographics, economic status, education level and maternal health status.

RESULTS

A weight gain of 15.2 kg resulted in model-predicted intake during pregnancy of 2,882.97 ±  135.71 kcal day-1, which differed from self-reported intake of 2,180.5 ± 856.0 kcal day-1. The achieved weight gain exceeded the IOM guidelines; however, the model predicted weight gain from self-reported energy intake was below IOM guidelines. Higher income (p = 0.004), education (p = 0.003), birth weight (p = 0.017), gestational diabetes (p = 0.008) and pre-existing diabetes (p < 0.001) were associated with under-reported energy intake. More children living at home (p = 0.001) were associated with more accurate self-reported intake.

CONCLUSIONS

When assessing self-reported energy intake in pregnancy studies, birth weight, gestational diabetes status, pre-existing diabetes, higher income and education predict higher under-reporting. Clinicians providing dietary treatment recommendations during pregnancy should be aware that individuals with pre-existing diabetes and gestational diabetes mellitus are more likely to misreport their intake. Additionally, the systems model approach can be applied early in intervention to objectively monitor dietary compliance to treatment recommendations.

Functional role of apoptosis in oral diseases: An update

Cell death appears to be a basic biological phenomenon which is maintained by the human body. The term apoptosis, also known as programmed cell death, is characterized by several unique morphological and biochemical features. Apoptosis and its different forms are essential for tissue homeostasis. Alteration in molecular mechanisms involved in apoptotic signaling contributes to a vast range of oral diseases. An understanding of the regulation of apoptosis has led to the development of many therapeutic approaches and better management of oral diseases. The review updates us the correlation between apoptosis in normal oral tissues and oral diseases.

Management of myofascial pain by therapeutic ultrasound and transcutaneous electrical nerve stimulation: A comparative study

OBJECTIVE

The present comparative study was aimed to determine the effectiveness of Th US and TENS in the management of myofascial pain in TMD patients.

MATERIALS AND METHODS

The present randomized comparative study was on 90 patients who were further assigned in three different groups each having 30 patients; Group I was healthy control patients, Group II was receiving Th US therapy, and Group III was receiving TENS therapy. All the 90 patients were further evaluated for maximum inter incisor subjective evaluation regarding muscle pain, impediment to daily life, massage impression on visual analog scale (VAS) scale, and intensity and duration used in Th US massage.

RESULTS

The masseter muscle thickness in control group was 12.00 (standard deviation [SD] ±1.1) mm when compared with TMD patient of 13.00 (SD ± 1.1) mm before treatment. Statistical significant findings on VAS score of muscle pain, impediment to daily life, and massage impression were observed in Th US. After treatment, the anechoic areas disappeared or were reduced in Th US group by 95.6% and in TENS by 74.4%.

CONCLUSION

Th US appeared to be subjectively better which was related to VAS score of massage impression, muscle pain, and impediment to daily life after treatment as well as sonographically related to existence of anechoic areas.

Computed Tomography in Diagnosis of Admantinoma

Context:

Admantinoma is second most common benign odontogenic tumor which clinically appears as an aggressive odontogenic tumor, often asymptomatic and slow growing, associated with symptoms such as swelling, dental malocclusion, pain, and paresthesia of the affected area. The radiographic appearance may vary from unilocular to multilocular radiolucencies, imparting a characteristic honey comb, soap bubble appearance or may resemble a caricature of spider.

Case Report:

This report highlights the importance of conventional and advanced imaging in the diagnosis of large and invasive lesions. Patient reported with complaint of swelling in jaw, which progressively increased; and was found to be bony hard, both intra- and extraorally. Radiographs revealed large multilocular radiolucency on left body and ramus of mandible with soap bubble pattern and knife edged root resorption. Computed tomographic examination evaluated the extent of the lesion, internal structure, and relation to adjacent structures; further a reconstructed image was obtained to evaluate extent of destruction in three dimensions.

Conclusion:

Computed tomography has an important role in the diagnosis and treatment planning is imperative as it is superior in revealing the cortical destruction and extension into the neighboring soft tissues than conventional radiography.

A recoil ion momentum spectrometer for molecular and atomic fragmentation studies

We report the development and performance studies of a newly built recoil ion momentum spectrometer for the study of atomic and molecular fragmentation dynamics in gas phase upon the impact of charged particles and photons. The present design is a two-stage Wiley-McLaren type spectrometer which satisfies both time and velocity focusing conditions and is capable of measuring singly charged ionic fragments up-to 13 eV in all directions. An electrostatic lens has been introduced in order to achieve velocity imaging. Effects of the lens on time-of-flight as well as on the position have been investigated in detail, both, by simulation and in experiment. We have used 120 keV proton beam on molecular nitrogen gas target. Complete momentum distributions and kinetic energy release distributions have been derived from the measured position and time-of-flight spectra. Along with this, the kinetic energy release spectra of fragmentation of doubly ionized nitrogen molecule upon various projectile impacts are presented.

Electron and recoil ion momentum imaging with a magneto-optically trapped target

A reaction microscope (ReMi) has been combined with a magneto-optical trap (MOT) for the kinematically complete investigation of atomic break-up processes. With the novel MOTReMi apparatus, the momentum vectors of the fragments of laser-cooled and state-prepared lithium atoms are measured in coincidence and over the full solid angle. The first successful implementation of a MOTReMi could be realized due to an optimized design of the present setup, a nonstandard operation of the MOT, and by employing a switching cycle with alternating measuring and trapping periods. The very low target temperature in the MOT (∼2 mK) allows for an excellent momentum resolution. Optical preparation of the target atoms in the excited Li 2(2)P3/2 state was demonstrated providing an atomic polarization of close to 100%. While first experimental results were reported earlier, in this work, we focus on the technical description of the setup and its performance in commissioning experiments involving target ionization in 266 nm laser pulses and in collisions with projectile ions.

Dentinogenic ghost cell tumor - a neoplastic variety of calcifying odontogenic cyst: case presentation and review

CONTEXT

The calcifying odontogenic cyst (COC), also referred to as calcifying ghost cell odontogenic cyst (CGCOC) is a heterogeneous lesion existing either as cystic or solid variant. Due to the fact that all CGCOC lesions are not cystic, and the biological behavior is often not consistent with a cyst, there has always been a controversy as to whether COC is a cyst or a tumor. The dentinogenic ghost-cell tumor (DGCT), a solid variant of the COC, is an uncommon odontogenic neoplasm occurring predominantly in later life. Case report is followed by a concise review and disambiguation of controversial terminologies regarding nomenclature of COC.

CASE REPORT

We report a case of 33-year-old female patient who presented with an insidious, steadily increasing swelling on the left side of her face since 8 months. Patient reported slight difficulty in eating because of reduced intraoral space and an obvious concern with facial disfigurement. There was no contributory dental or medical history. Intraorally, a hard, well defined, bicortical swelling was noted in left maxillary region with slight mobility of the associated teeth and normal appearing overlying mucosa. A provisional diagnosis of adenomatoid odontogenic tumor was made, and orthopantomogram, paranasal sinus radiograph and computed tomograpy scan of the face were acquired. A radiographic diagnosis of COC was made, which was subsequently confirmed on histopathology postenucleation of the tumor mass. COC has been seen to be of extensive diversity in its clinical and histopathological features as well as in its biological behavior.

CONCLUSION

The present case of 33-year-old female was diagnosed as DGCT, a tumorous form of COC, due to its characteristic histological features; numerous ghost cells and dentinoid material.

CT imaging for evaluation of calcium crystal deposition in the knee: initial experience from the Multicenter Osteoarthritis (MOST) study

OBJECTIVE

Role of intra-articular calcium crystals in osteoarthritis (OA) is unclear. Imaging modalities used to date for its evaluation have limitations in their ability to fully characterize intra-articular crystal deposition. Since Computed Tomography (CT) imaging provides excellent visualization of bones and calcified tissue, in this pilot project we evaluated the utility of CT scan in describing intra-articular calcium crystal deposition in the knees.

METHOD

We included 12 subjects with and four subjects without radiographic chondrocalcinosis in the most recent visit from the Multicenter Osteoarthritis (MOST) study, which is a longitudinal cohort of community-dwelling older adults with or at risk for knee OA. All subjects underwent CT scans of bilateral knees. Each knee was divided into 25 subregions and each subregion was read for presence of calcium crystals by a musculoskeletal radiologist. To assess reliability, readings were repeated 4 weeks later.

RESULTS

CT images permitted visualization of 25 subregions with calcification within and around the tibio-femoral and patello-femoral joints in all 24 knees with radiographic chondrocalcinosis. Intra-articular calcification was seen universally including meniscal cartilage (most common site involved in 21/24 knees), hyaline cartilage, cruciate ligaments, medial collateral ligament and joint capsule. Readings showed good agreement for specific tissues involved with calcium deposition (kappa: 0.70, 95% CI 0.62-0.80).

CONCLUSION

We found CT scan to be a useful and reliable tool for describing calcium crystal deposition in the knee and therefore potentially for studying role of calcium crystals in OA. We also confirmed that "chondrocalcinosis" is a misnomer because calcification is present ubiquitously.

Incident long-term warfarin use and risk of osteoporotic fractures: propensity-score matched cohort of elders with new onset atrial fibrillation

Association between warfarin use and fracture risk is unclear. We examined the association between long-term warfarin use and fracture risk at the hip, spine, and wrist in elders. No significant association was found between long-term warfarin use and fracture risk, despite biological plausibility.

INTRODUCTION

Prior studies examining the association of warfarin use and osteoporotic fractures have been conflicting, potentially related to methodological limitations. Thus, we examined the association of long-term warfarin use with risk of hip, spine, and wrist fractures among older adults with atrial fibrillation, attempting to address prior methodologic challenges.

METHODS

We included men and women ≥ 65 years of age with incident atrial fibrillation and without prior history of fractures from The Health Improvement Network followed between 2000 and 2010. Long-term warfarin use was defined in two ways: (1) warfarin use ≥ 1 year; (2) warfarin use ≥ 3 years. Propensity-score matched cohorts of warfarin users and nonusers were created to evaluate the association between long-term warfarin use and risk of hip, spine, and wrist fractures separately as well as combined, using Cox-proportional hazards regression models.

RESULTS

Among >20,000 participants with incident atrial fibrillation, the hazard ratios (HR) for hip fracture with warfarin use ≥ 1 and ≥ 3 years, respectively, were 1.08 (95%CI 0.87, 1.35) and 1.13 (95% CI 0.84, 1.50). Similarly, no significant associations were observed between long-term warfarin use and risk of spine or wrist fracture. When risk of any fracture was assessed with warfarin use, no association was found [HR for warfarin use ≥ 1 year 0.92 (95%CI 0.77, 1.10); HR for warfarin use ≥ 3 years 1.12 (95%CI 0.88, 1.43)].

CONCLUSIONS

Long-term warfarin use among elders with atrial fibrillation was not associated with increased risk of osteoporotic fractures and therefore does not appear to necessitate additional surveillance or prophylaxis.