Multiple oral mucoceles treated with evening primrose oil: a report of two cases

Multiple mucoceles of the minor salivary glands are rare in the mouth. Typically, the minor salivary glands of the soft palate are affected. We report two cases that responded entirely following systemic therapy with evening primrose oil. No recurrence was reported over a two-year follow-up period. Evening primrose oil is postulated to have an effect on the composition and/or viscosity of minor salivary gland secretions.

Prevalence of Vascular Calcification in Chronic Kidney Disease Stage 4 and 5 Patients and its Correlation with Inflammatory Markers of Atherosclerosis

Vascular calcification is one of the independent risk factors associated with cardiovascular disease (CVD) in chronic kidney disease (CKD) patients. This study evaluated the prevalence of vascular calcification in Indian patients with CKD stages 4 and 5. This was a prospective study conducted between January 2011 and June 2012. CKD stage 4 and 5 patients of either sex aged >18 years were screened for aortic vascular calcification using digital X-ray lumbar spine and multislice computed tomography (CT) scan. In addition, details of inflammatory markers [high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL-6)] were also collected. A total of 150 patients (stage 4, n = 98; stage 5, n = 56) were screened for vascular calcification, and the mean age was 56.56 years. Patients with CKD stage 5 had significantly higher (P ≤0.05) serum creatinine and lower estimated glomerular filtration rate, total cholesterol, and low-density lipoprotein than CKD stage 4. Significantly, more patients with CKD stage 5 had a history of CVD. A total of 113 (75.3%) patients had vascular calcification [aortic calcification index (ACI) >0] with significantly higher prevalence in CKD stage 5 (85.72%) as compared to CKD stage 4 (69.15%). Patients having high aortic calcification (ACI >20%) were older (P = 0.0013); had a higher frequency of diabetes, and CVD; and had significantly (P <0.05) higher blood urea, serum creatinine, phosphorus, Ca × PO4 product, intact parathyroid hormone, hs-CRP, and IL-6. The higher CKD stage was associated with a higher prevalence of vascular calcification and higher aortic calcification index (ACI). CT techniques (electron beam CT and multislice CT) are the gold standards for detection and quantification of progression of vascular calcification.

Primary tubercular chest wall abscess in a young immunocompetent male

Chest wall tuberculosis is a rare entity especially in an immunocompetent patient. Infection may result from direct inoculation of the organisms or hematogenous spread from some underlying pathology. Infected lymph nodes may also transfer the bacilli through lymphatic route. Chest wall tuberculosis may resemble a pyogenic abscess or tumour and entertaining the possibility of tubercular etiology remains a clinical challenge unless there are compelling reasons of suspicion. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. We present here a case of chest wall tuberculosis where infection was localized to skin only and, in the absence of any evidence of specific site, it appears to be a case of primary involvement.

High Resolution Computed Tomography Lung Spectrum in Symptomatic Adult HIV-Positive Patients in South-East Asian Nation

BACKGROUND

Pulmonary infections remain a leading cause of morbidity and mortality and one of the most frequent causes of hospital admission in HIV infected people worldwide. HRCT may be useful in the evaluation of patients with suspected pulmonary disease. The aim of given study was to determine the High Resolution Computed Tomography spectrum of lung parenchymal and interstitial imaging findings in HIV infected patients presented with chest symptoms.

MATERIALS AND METHODS

This study was conducted in a tertiary health care centre, New Delhi, India. The study consisted of 45 patients. A thorough clinical history of all the HIV positive patients presenting with suspicion of pulmonary disease was taken. General physical and respiratory system examination of all patients was done. HRCT scans of the chest were done in all the cases taken in the study.

RESULTS

Maximum number of patients was in age group 31-40 years (24 cases). Out of 45 patients included in our study, 32 (71%) were male and 13 (29%) were female. In our series of 45 patients, 62.2% of patients were diagnosed as having pulmonary tuberculosis, followed by bacterial infection in 20% cases and Pneumocystis jiroveci pneumonia (PJP) in 8.9% patients, while 8.9% of the study did not reveal any significant abnormality. Maximum number (22/28) of patients with pulmonary tuberculosis were indentified to have nodular opacities. The most common HRCT finding in bacterial infection was lobar consolidation. The most common HRCT finding in patients with PCP was diffuse ground glass opacities in mosaic pattern of distribution.

CONCLUSION

HRCT is a highly sensitive tool for detecting lung parenchymal and interstitial lesions and allows better characterization of the lesions. HRCT findings should always be correlated with clinical findings, CD4 counts and other available investigations before arriving at a diagnosis or differential diagnosis.

Tubercular liver abscess: a distinct entity not to be missed

BACKGROUND

Liver abscess is fairly common in developing countries and its incidence is ever-rising. Though amoebic and pyogenic liver abscesses form majority of cases in our country, tubercular liver abscess (TLA) should also be considered as differential diagnosis.

AIMS

To study the clinical and imaging profile of tubercular liver abscess while establishing its increased incidence.

METHODS

A prospective observational study was carried out on 72 indoor cases of liver abscess, presenting to Department of Medicine, from November 2011 to February 2013. All cases were subjected to abscess tap and tapped abscess was sent for microbiological examination.

RESULTS

Though amoebic liver abscess was most common type diagnosed, five cases came out to be tubercular (AFB positive). Mean age of TLA patients was 28.4 years (all males). All cases were sub-acute in presentation. Splenomegaly and ascites were noted in 60% and 40% cases respectively. ESR was raised in 80% cases with mean value of 52.8 mm at first hour. Haemoglobin was low in 80% cases. Serum Alkaline phosphatise (ALP) was raised in all cases, mean value being 1034.4 U/L. On ultrasonography, all abscesses were < 5 centimetres in size, most commonly involving seventh segment. They were multiple in numbers in 60% cases. All cases responded well to anti-tubercular treatment.

CONCLUSIONS

Tubercular liver abscess has increased in incidence, and in majority of cases in our study, they were incidentally found with no associated foci of infection in lung or gastrointestinal tract. So, keeping high index of suspicion, TLA should be considered in all patients with subacute presentation and associated anaemia, splenomegaly or ascites. Also, TLA is associated with raised ESR and comparatively higher levels of ALP in serum. They are more commonly multiple in number on ultrasonography.

Primary pioglitazone failure in Asian Indian diabetics is not related to common Pro12Ala polymorph of PPAR-gamma gene

To determine the various factors influencing glycemic response to pioglitazone monotherapy in newly diagnosed Asian Indian T2DM patients. Thirty T2DM patients (age 53.23 +/- 8.067 yrs, M: F ratio 14:16) were treated with pioglitazone for at least 14 weeks. Relationship between its glucose lowering effect and following patient parameters was studied: BMI, W:H ratio, HOMA-R, HOMA-beta and Pro12Ala polymorph of PPAR-gamma gene. Glycemic targets could be achieved in 20 (66.67%) subjects. All the parameters were comparable among responders and non-responders at the start of therapy. All the participants were homozygous for Pro allele of Pro12Ala polymorph of PPAR-gamma gene. There was a significant positive association between glycemic response to pioglitazone and W: H ratio (beta = 0.426, P = 0.034) and HOMA-R (beta = 0.563, P = 0.008). Primary pioglitazone failure cannot be explained on the basis of body fat and its distribution, insulin resistance and secretory function and Pro12Ala polymorph of PPAR-gamma gene. Among responders central obesity and high insulin resistance were associated with better glycemic response.

AgNOR counts in cervical lesions

Present study was undertaken with a view to assess the utility of AgNOR counts in differentiating cervical lesions. One hundred cases of cervical lesions including normal, chronic cervicitis, CIN (I, II, III) and carcinoma were taken up for study during the period December 1995 to November 1996. Three micron thick sections of paraffin were subjected to AgNOR staining as described by Crocker and Smith with a little modification of 0.01% safranin counterstain. Statistical counts of AgNORs were done. The mean AgNOR counts in cervical epithelium showed a progressive and statistically significant increase from normal to chronic cervicitis to CIN, I, II and III (P<0.001). Scores in carcinoma also exceeded that of CIN (P<0.05). This can prove to be a useful adjunct to routine histopathology to evaluate cervical lesions.

Evaluation of AgNORs in pulmonary lesions: a cyto-histopathological correlation

Silver nucleolar organizer regions (AgNORs) were studied in one hundred specimens of endobronchial brushings. Bronchial biopsies were also obtained from these one hundred cases and subjected to AgNOR staining. These included twenty histologically normal cases, ten cases of inflammatory pathology and seventy cases of pulmonary neoplasms. Fixed cytologic smears and three micron thick sections of paraffin embedded tissue were subjected to AgNOR staining. The mean AgNOR counts in bronchial tissue showed a progressive and statistically significant increase from normal, through inflammatory to neoplastic lesions in both cytologic smears and histopathologic specimens. The AgNOR technique is simple, inexpensive and a useful adjunct to routine histopathology, to evaluate pulmonary lesions. The counts, however, cannot be standardized for a particular lesion as there are inter-laboratory variations.

Bypassing hybridoma technology: HLA-C reactive human single-chain antibody fragments (scFv) derived from a synthetic phage display library (HuCAL) and their potential to discriminate HLA class I specificities

The generation of discriminative, monospecific anti-HLA antibodies used to be a difficult endeavor. Phage display technology, using single-chain antibody fragments (scFv) offers a powerful alternative obtaining target-specific, genetically stable reagents. Most of scFv obtained to date have been enriched by panning phage libraries to solid-phase coupled antigens. In the present study, HLA-C-specific scFv were isolated using a synthetic phage library in combination with a Cw*0602 overexpressing cell line. ScFv from this procedure precipitated HLA-Cw*0602 heavy chains from whole cell lysates. Flow cytometry analysis revealed that scFv stained HLA-Cw*0602-positive cells, but not cells expressing HLA alleles Cw*0302, Cw*0802, A*0201, B*2705, or Gm1*01011, indicating the specificity of scFv. Similarly they showed an ability to discriminate Cw*0602-positive from Cw*0602-negative peripheral blood lymphocytes (PBL). The results of our study demonstrate the feasibility to genetically engineer single-chain HLA-class I-specific antibodies, by phage display technology. This approach might be a valuable tool to develop a broad range of novel monospecific antibodies against HLA-class I specificities.

AgNORs in endometrial lesions

Silver nucleolar organizer region (AgNOR) staining was employed in one hundred specimens of endometrium. These included fifteen normal controls (Proliferative + Secretory endometrium) and eighty five lesions. Endometrial lesions comprised of endometritis (15), endometrial hyperplasia (25) and endometrial carcinoma (45). Three micron thick sections of paraffin embedded tissue were subjected to AgNOR staining as described by Crocker and Smith with a little modification of 0.01% safranin counterstain--The mean AgNOR scores were found to increase steadily from normal to endometritis to endometrial hyperplasia and carcinoma--The observations revealed statistically significant differences in values between atypical hyperplasia and carcinoma also. AgNOR staining and scoring is simple, inexpensive and a useful adjunct to routine histopathology to evaluate endometrial lesions especially to differentiate borderline lesions. Though scores cannot be standardized and fixed for a particular lesion as there are intralaboratory variations.

Topical liposome system bearing local anaesthetic lignocaine: preparation and evaluation

Topical multiple lamellar vesicular liposomes were formulated by using the method reported by Bangham (1968). The liposomes, composed of different lipid and charge-bearing components such as stearylamine or dicetylphosphate, were characterized for average size, size distribution, charge lamellae and drug loading. The negatively charged liposomes showed high drug loading and were incorporated in different topical vehicles, i.e. gels and ointment. These were evaluated for in vitro drug skin permeation profile. The selected formulations were evaluated for in vivo performance using the pinprick method. The results revealed localized and prolonged activity of local anaesthetic contained in liposomes when compared with equivalent conventional topical application.

Adolescent blood pressure survey: Tulsa, Oklahoma, 1987 to 1989

The study goals were to document the incidence of elevated blood pressure (BP) values in public high school students in Tulsa, Oklahoma; to determine whether age and sex are risk factors; and to encourage adolescents with abnormal screening BP values to seek medical care. Over a 2-year period, 5537 adolescents aged 14 to 19 years were evaluated by a mass screening method. Blood pressure was measured once between 8:30 and 9:30 AM, with the students seated. Korotkoff phases 1 and 5 were recorded as systolic and diastolic BP. According to the criteria of the Second Task Force on Hypertension in Children and Adolescents, 334 students had elevated BP values (either systolic, diastolic, or both) (an incidence of 6%). Boys had an incidence of elevated systolic BP of 5.8%, while girls had a 2.8% incidence, a difference that might have been expected because of the generally higher incidence among men in the adult population. The incidence of elevated diastolic BP was 2.8% in boys and 2.1% in girls. Statistically significant differences between boys and girls mean systolic and diastolic elevations were found, but were not considered clinically significant. An instructional mailing was done in an effort to stimulate follow-up medical care for those with abnormal findings, but its effect was not measured.

Hypocholesterolaemic effects of dietary fibre

Role of dietary fibre in lowering serum cholesterol has been studied in mongrel dogs. Pectin, wheat bra, guar gum and Isabghol were fed with standard diet. No statistically significant changes were found in serum cholesterol levels in any groug (P greater than .05) after one week. Later by 15th day, pectin reduced serum cholesterol significantly i.e. 12.4% (P less than .02). However, in groups being fed other forms of fibre the levels of serum cholesterol were reduced by 3.8% to 7.0

Urethral diverticulum in male subjects: report of 5 cases

We present 5 cases of urethral diverticulum in male subjects, of which 2 were congenital and 3 were acquired. Of these diverticula 4 were in the anterior urethra, while 1 was in the posterior urethra. One congenital diverticulum contained multiple calculi.

alpha-I antitrypsin enzyme deficiency in Indian childhood cirrhosis

Antitrypsin activity was measured in 50 healthy controls and 100 cases of Indian Childhood Cirrhosis (ICC). The incidence of alpha-I anti-trypsin (Alpha I-AT) enzyme deficiency was strinkingly higher in cases of cirrhosis (39.0%) than in healthy controls (4%). The enzyme deficiency was more prevalent in severe grades of cirrhosis (51.5%) as compared to mild (17.6%) and moderate cirrhosis (38%). Liver function tests were severely deranged in enzyme deficient cirrhotics and the damage to the liver was directly proportional to the extent of the enzyme deficiency. The incidence of the family history of ICC was noted significantly higher in enzyme deficient cases (20%) as compared to non-deficient cases (3.3%). The enzyme deficiency was also measured in 160 first blood relatives of the deficient cirrhotics and was found to be deficient in 19.4% subjects. It is probable that the deficiency runs in families with an autosomal recessive mode of inheritance.