Evaluation of RURS elbow guard in the management of thumb-sucking habit in children with and without intellectual disability

BACKGROUND

Digit sucking is a common oral habit among many children, which involves placing the thumb/finger into the mouth, which can cause malocclusion in mixed and permanent dentition.

AIM

To evaluate the efficacy of the RURS elbow guard in the management of thumb-sucking habits in children with intellectual disabilities and those without in terms of the mean duration of appliance therapy. The secondary objective was to compare the RURS elbow guard with an intraoral crib in healthy children (without intellectual disabilities) to manage the habit of thumb-sucking.

DESIGN

Children with intellectual disabilities and those without between the age of 4 and 16 years were included in the study and categorised into three groups, namely group I (50 normal children; intraoral crib appliance), group II (50 normal children; RURS elbow guard) and group III (50 children with intellectual disabilities; RURS elbow guard).

RESULTS

The mean duration of appliance therapy for groups I, II and III were 200.20 ± 20.43 days, 204.34 ± 20.56 days, and 218.43 ± 15.66 days, respectively (p < 0.001). The differences in the mean duration between group I and group II were statistically non-significant, with statistically significant differences between group I and group III (p < 0.001) and between group II and group III (p < 0.05).

CONCLUSION

The RURS elbow guard was found to be an efficient appliance in treating thumb-sucking among children who had mild to moderate intellectual disabilities. RURS elbow guard was equally efficient as an intraoral crib appliance in managing thumb-sucking habits in children without intellectual disabilities.

First presentation of pyoderma gangrenosum in a patient with partial immunoglobulin A deficiency

We describe the case of a 58-year-old female with an intensely painful and rapidly enlarging necrotic cutaneous ulcer to the right shin on a background of partial immunoglobulin A deficiency (IgAD). She was seen by various healthcare professionals and managed with upscaling antibiotics for cellulitis requiring an inpatient hospital stay. The dermatology team made a clinical diagnosis of ulcerative Pyoderma Gangrenosum (PG) on assessing the patient 13 days post-onset of symptoms. The patient responded dramatically to steroids and oral tetracycline. This case highlights the unusually described association between PG and IgAD as well as the diagnostic challenge seen in patients presenting with PG.

Comparative evaluation of the effects of bimaxillary and mandibular setback surgery on pharyngeal airway space and hyoid bone position in skeletal class III patients

Background

To compare the effects of bimaxillary surgery ( Maxillary advancement and mandibular setback) and mandibular setback surgery (Bilateral Sagittal Split Osteotomy) on the pharyngeal airway space (PAS) and the hyoid bone position in a skeletal class III patients.

Material and Methods

Thirty four subjects (21 males, 13 females, mean age 26.5 ± 8 years) with skeletal class III pattern (ANB angle of -2° to -6°) were divided into two groups of equal sizes. Group A consisted of 17 individuals who underwent Bilateral Sagittal Split Osteotomy (BSSO)and Group B consisted of 17 individuals who underwent bimaxillary surgery. In both the group, lateral cephalograms were taken, traced and analyzed for the specified parameters at 3 intervals, pre treatment (C1), post surgical (C2), and post orthodontic treatment (C3). Changes in PAS was evaluated at 3 levels i.e, nasopharynx (Upper PAS), oropharynx (Middle PAS) and hypopharynx (Lower PAS). Changes in hyoid bone position were evaluated in anteroposterior and vertical direction at all the 3 intervals.

Results

There was a significant constriction of airway at oropharyngeal and hypo-pharyngeal level at C2 and C3 in both the groups. However, the reduction at the oropharyngeal airway was greater in group A. In group B, there was significant increase in the airway at the level of nasopharynx, Hyoid bone was positioned more posteriorly post-surgery in group A which did not return to its original position post treatment. In group B hyoid bone was positioned postero-inferiorly post surgically which came back to its original position by the end of orthodontic treatment.

Conclusions

Patients undergoing bimaxillary surgery showed a significant increase in the airway at the level of nasopharynx. Hyoid bone returned to its original position by the end of orthodontic treatment in the bimaxillary surgery group. This study suggested that while treating a skeletal class III malocclusion it is advised to perform maxillary advancements along with mandibular setback surgery.

Key words:Bimaxillary surgery, Hyoid bone, Bilateral Sagittal Split Osteotomy, Pharyngeal airway space.

Unusual presentation of an insulinoma in an elderly male patient

Insulinoma is a rare neuroendocrine tumor originating from hypersecreting beta-cells of islets of Langerhans in the pancreas. We report a case of 72-year-old male, with chronic alcohol abuse, presenting with atypical features like refractory recurrent secondary generalized seizures and behavioral disturbances with increased irritability, initially mistreated as alcohol withdrawal. Detailed history, particularly the relationship of the symptoms with food intake, made us think of other causes of seizures. Fasting biochemical investigations and localizing studies helped clinch the diagnosis. The tumor was localized with the help of endoscopic ultrasonography and whole-body Ga68-DOTANOC PET-CT. The patient was treated conservatively with diazoxide and is doing well on follow-up. The present case report emphasizes the importance of detailed clinical history, more so in atypically presenting cases of refractory seizures. Insulinoma can be medically managed despite surgery being the gold standard curative treatment.

Hemophagocytic lymphohistiocytosis secondary to infections: a tropical experience!

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyper inflammatory condition, if not recognized and treated in time. A high index of suspicion can help identify the condition early. This condition can occur in the primary or secondary form. Secondary HLH or hemophagocytic syndrome (HPS) secondary to infections is an important clinical entity especially in tropical world. In this article, we share our experience with this entity and make an attempt to explore literature about ravenous macrophages which occurs secondary to infections. It is a series of six cases of HLH secondary to infectious disease in our center in a coastal city in South India over last one year with follow up.

Clinical evaluation of a sub-lingual vaccine for prevention of exacerbations in COPD

Background: Lower airway bacterial infection is one of the major cause for exacerbation inCOPD. Multicomponent vaccines derived from the various causative pathogens are shownto prevent the exacerbations.Aims and Objectives: The present study was carried out toevaluate the effi cacy of sublingual vaccine (Ismigen) in preventing the exacerbations inCOPD and to observe its tolerability.Materials and Methods: Twenty four COPD patientsmeeting the eligibility criteria were enrolled in the study. Ismigen was administered once aday sublingually for ten days a month for three consecutive months. They were observed over one year for exacerbations, hospitalisations, respiratory symptoms, lung function tests and adverse reactions. The mean scores of the parameters in the previous year were compared with that of the year following treatment. Students t test and Chi- square test were used for analysis. Results: The mean number of exacerbations reduced from 6.79±3.51 to 2.67±1.90 (p<0.001) and the mean number of hospitalisations from 2.29±1.85 to 0.67±0.87 (p<0.001). There was no significant change in the respiratory symptom score and lung function test. Mild non-serious adverse event was reported by one patient.Conclusion: The results indicated that Ismigen could be an effective and well-tolerated add on therapy in COPD to reduce the frequency and severity of exacerbations.DOI: http://dx.doi.org/10.3126/ajms.v6i4.11634 Asian Journal of Medical Sciences Vol.6(4) 2015 51-54

Hemophagocytic lymphohistiocytosis

Hemophagocytic lymphohistiocytosis (HLH) is an immune disorder characterized by uncontrolled inflammation due to defective immune response. It may be familial or acquired, but both share a common feature of threatening the life of a patient and may lead to death unless treated by appropriate treatment. Here in we report a case of adult HLH.

Sevelamer carbonate experience in Indian end stage renal disease patients

This open label, multicentric, comparative clinical trial was done to compare the efficacy and tolerability of two sevelamer formulations, sevelamer carbonate, and sevelamer hydrochloride, in the treatment of hyperphosphatemia in Indian end stage renal disease (ESRD) patients. A total of 97 ESRD patients on hemodialysis, were enrolled. Patients were randomized to receive either sevelamer carbonate or sevelamer hydrochloride. All patients were evaluated every week for 6 weeks for efficacy and safety variables. Total 88 patients completed the study. After 6 weeks of therapy, there were similar reductions (P<0.0001) in mean serum phosphorus and the CaxP product both the groups. The responder rates for test and reference groups were 75%, 68.18% respectively (P=0.3474). The adverse events reported were nausea, abdominal pain/discomfort, heartburn, constipation, diarrhea, increased prothrombin time, and severe arthritis. No serious adverse events were reported. There was no significant difference between the groups for adverse events and the laboratory parameters. From the results of this multicentric, comparative, randomized clinical study on sevelamer carbonate we can recommend that sevelamer carbonate may be used as a phosphate binder in Indian chronic kidney disease patients.

Immune reconstitution and inflammatory syndrome due to disseminated tuberculosis in a case of human immunodeficiency virus 2 infection

We present a case of human immunodeficiency virus 2 (HIV- 2) infection with acquired immune deficiency syndrome with immune reconstitution and inflammatory syndrome due to disseminated tuberculosis. We address here the drug interactions between antiretroviral therapy and antituberculous treatment (ATT), choice of ATT, and duration of ATT when rifampicin is omitted as in our case. Though this problem is encountered rarely, we felt that it is important to report the issue to counter drug resistance in tuberculosis and HIV.

Preoperative ultrasound in de Quervain's disease: an investigation worth doing

BACKGROUND

The diagnosis of de Quervain's disease is traditionally clinical. There are no defined objective criteria to select a mode of treatment (conservative or surgical). Usually, all cases are initially treated conservatively and are offered surgery if it fails. Persistent symptoms after surgery, a nightmare for treating surgeon, are attributed to improper diagnosis or inadequate release of the compartment.

METHODS

A total of 45 symptomatic wrists in 42 patients were analyzed. All patients underwent ultrasound examination using a 12 MHz linear array transducer by the same radiologist in both the affected and unaffected wrists.

RESULTS

The highest incidence was seen in housewives involved in domestic work.

CONCLUSION

Ultrasound is a worthwhile preoperative investigation in case of de Quervain's disease.

Lumbosacral transitional vertebra: clinical and forensic implications

The identification of skeletal remains is one of the classic problems faced by forensic experts. Congenital and acquired malformations can prove to be an important tool for identification, provided antemortem records are available. A lumbosacral transitional vertebra is one such rare congenital anomaly that has clinical and medicolegal implications. We report a case of unilateral lumbosacral transitional vertebra, detected during medicolegal examination of skeletal remains that were recovered from a forested area in coastal Karnataka, India. The congenital anomaly of the transitional vertebra helped in the forensic identification of the deceased.

High rates of paraquat-induced suicide in southern Trinidad

The suicide rate in Trinidad and Tobago is much greater than that of its English-speaking Caribbean neighbors. Many of these suicides are paraquat induced. This research reviewed the deaths due to suicide in the area with the greatest agricultural activity in Trinidad for 1996 and identified, for further demographic and etiological investigation, cases in which paraquat was ingested as the agent of suicide. Of 48 cases of suicide for the year, 39 (81.3%) were due to paraquat poisoning. The incidence of paraquat-induced suicide was 8.0 per 100,000. Among the males, 47.8% were in the age group 25-34 (p < 0.001), and among the females 50.0% were in the 15-24 age group (p < 0.05). Family-of-origin disputes were the most frequently cited precipitant, followed by marital problems. Individuals of East Indian origin accounted for 89% of the suicide victims (p < 0.001). When compared with suicide by other methods in the country, these findings confirm that paraquat poisoning is a significant means of suicide in Trinidad and that young East Indian individuals are particularly vulnerable.

Stimulation of glucose transport in Clone 9 cells by insulin and thyroid hormone: role of GLUT-1 activation

Thyroid hormone (T3) and insulin are both shown to stimulate glucose transport in Clone 9 cells, a rat liver cell line in which the utilization of glucose is limited by transport rate and in which only the GLUT-1 transporter isoform is expressed. Pre-treatment of these cells with T3 moreover substantially enhances the stimulatory effect of insulin such that at maximally effective hormone concentrations the effects of T3 and insulin on glucose transport are more than additive and indeed nearly multiplicative, suggesting that the mechanisms mediating the enhancement of glucose transport differ between the two hormones. Cell surface biotinylation followed by Western-blot analysis of plasma membrane fractions showed that the stimulatory effects of T3 and insulin on glucose transport, whether acting singly or in combination, exceed the attendant increases in the abundance of GLUT-1 in the plasma membrane. It is suggested that activation of GLUT-1 molecules pre-existing in the plasma membrane plays a major role in mediating the stimulatory effects of T3 and insulin on glucose transport in this cell line.

In vitro susceptibility of multiple drug resistant Salmonella typhimurium to newer fluroquinolone derivatives

A total of 105 strains of Salmonella typhimurium resistant to Ampicillin, Co-trimoxazole and Nalidixic acid were included in the present study. Among the new line of Fluroquinolones resistance to Ciprofloxacin (3.8%), Norflox (16.19%) and Ofloxacin (24.76%) was very low as compared to older antibiotics. All the 3 fluoroquinolones had MIC values less than 1 mcg/ml.

Viral diarrhoea in a rural coastal region of Karnataka India

A total of 106 children below 5 years of age admitted to the Kasturba Medical College Hospital Manipal Karnataka (South India) were investigated over a period of 6 months to determine the aetiological role of viruses in acute diarrhoea. Viral aetiological agents isolated were Rotaviruses in 12 (11 per cent) cases, Adenoviruses in 3 (3 per cent) cases, coronavirus and astroviruses in two (2 per cent) cases each. Non-viral isolates were Cryptosporidium and Salmonella typhimurium in two cases each, and Entamoeba histolytica and Shigella flexneri in one case each.

Antibacterial activity of tea (Camellia sinensis) and coffee (Coffee arabica) with special reference to Salmonella typhimurium

Extracts of Black tea, Japanese green tea, China tea or Coffee inhibited the growth of various bacteria causing diarrhoeal diseases. Tea or coffee also showed bactericidal activity against Vibrio cholerae, Salmonella typhimurium and Salmonella typhi.

Correlation of phospholipase A & enterotoxin production by Salmonella typhimurium with reference to virulence parameters

Seventy strains of S. typhimurium along with 10 strains each of S. typhi and S. paratyphi B, 3 strains of S. enteritidis and 2 strains of S. senftenberg were examined for phospholipase A (PLA) activity. S. typhimurium positive for PLA activity (17.14%) were subjected to study of other virulence parameters like enterotoxin production, haemolytic activity, surface hydrophobicity and antibiotic sensitivity. A high degree of correlation was observed between PLA activity and enterotoxin production, antibiotic sensitivity and cell surface hydrophobicity respectively.

Rapid identification of Salmonella typhimurium in stools by using 4-methylumbelliferone derivatives

A total of 150 stool samples were collected from the Paediatric ward and screened for the presence of Salmonella typhimurium. A comparison of standard biochemical tests and rapid fluorescence method was done. The fluorescence method was found to be rapid, less time consuming and easy to perform whereas identification of Salmonella typhimurium using standard biochemical tests taken 18 to 24 hours.

Induction of GLUT1 mRNA in response to inhibition of oxidative phosphorylation

In previous studies, we have shown that inhibition of oxidative phosphorylation in Clone 9 cells (a nontransformed rat liver cell line) by 5 mM azide results in a marked biphasic stimulation of glucose transport that is mediated by GLUT1 [M. Shetty, J. N. Loeb, and F. Ismail-Beige. Am.J. Physiol. 262 (Cell Physiol. 31): C527-C532, 1992]. The late phase of the response (at 8-24 h) is associated with a doubling of cell GLUT1 content and an 8- to 10-fold increment in GLUT1 mRNA abundance. To investigate the mechanisms mediating GLUT1 mRNA induction, we have examined the effect of incubation in the presence of azide on GLUT1 gene transcription. In nuclear run-on assays, the rate of GLUT1 gene transcription was increased 2.5 +/- 0.3-fold in nuclei from cells exposed to azide for 4 h. Additionally, GLUT1 mRNA turnover was decreased in cells treated with azide: upon inhibition of RNA synthesis by actinomycin D, GLUT1 mRNA content decreased with half-lives of 2.3 +/- 0.3 and 8.0 +/- 0.5 h in control cells and cells treated with azide for 4 h, respectively. GLUT1 mRNA half-life was most prolonged (> 12 h) when azide was added subsequent to the addition of actinomycin D, and the half-life continued to be prolonged (6.5 +/- 0.5 h) in cells exposed to azide for 16 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid activation of GLUT-1 glucose transporter following inhibition of oxidative phosphorylation in clone 9 cells

Exposure of Clone 9 cells to inhibitors of oxidative phosphorylation results in a rapid and striking stimulation of facilitated glucose transport (7.5-fold at 2 h) that is mediated by the GLUT-1 transporter. We have previously shown that this rapid stimulation of glucose transport occurs in the absence of any detectable increase in cell GLUT-1 or GLUT-1 mRNA content. To determine whether this early enhancement of transport is attributable to a translocation of glucose transporters to the plasma membrane, or instead to an activation of transporters already present in the plasma membrane, we have employed four different approaches to determine whether the stimulation of transport is accompanied by a corresponding increase in plasma membrane GLUT-1 sites: 1) immunofluorescence microscopy; 2) quantitation of GLUT-1 sites in plasma membrane fractions isolated by differential centrifugation and subsequent Western blotting; 3) cell surface biotinylated followed by isolation of plasma membranes and quantitation of GLUT-1 sites by Western blotting; and 4) quantitation of GLUT-1 sites in plasma membrane fractions by [3H]cytochalasin B binding. Each of these experimental approaches led to the same conclusion, namely that the large stimulation of glucose transport observed during the early phase of the response to azide is associated with only a slight increase in the abundance of GLUT-1 sites in the plasma membrane. These results strongly suggest that activation of GLUT-1 sites pre-existing in the plasma membrane is the dominant mechanism mediating the early glucose transport response to inhibition of oxidative phosphorylation.

Enhancement of glucose transport in response to inhibition of oxidative metabolism: pre- and posttranslational mechanisms

Addition of 5 mM sodium azide to Clone 9 cells, a rat liver cell line characterized by intracellular glucose concentrations of less than 10% that of the external medium and limited glycogen stores, results in a 50-80% reduction in cell ATP content within 20 min which then recovers to near-basal levels within 1 h and is subsequently maintained at normal levels for 24 h despite continuing the presence of the inhibitor. Associated with this adaptive response is a striking stimulation of facilitated glucose transport, mediated by the GLUT-1 transporter, that exhibits "early" and "late" phases that appear to be mechanistically different. During the early phase of the response (0-2 h), glucose transport rate is enhanced 12-fold in the absence of any change in cell GLUT-1 or GLUT-1 mRNA content. In contrast, the late phase of the response (8-24 h) is characterized by a further large stimulation of glucose transport (to 1.6 times the 2-h value) that is associated with 2- to 3- and 6- to 10-fold increments in cell GLUT-1 and GLUT-1 mRNA content, respectively. In time course studies an increase in GLUT-1 mRNA content was observed at 4 h and preceded the increment in GLUT-1 which became detectable after 8 h of exposure to azide. A marked induction of GLUT-1 mRNA by azide was also demonstrable in cells incubated in medium containing higher concentrations of glucose (10.6 mM), although the increment was approximately 20% less than when cells were incubated in standard medium (containing 5.6 mM glucose).(ABSTRACT TRUNCATED AT 250 WORDS)

Salmonella typhimurium isolated from bacteraemia

During a two year period, a total of 15 strains of S. typhimurium were isolated and analysed by phage typing. Of these, 13 were found untypable, while two strains belonged to phage 76 and 22. All the strains were sensitive to Gentamicin and Cephaloridine. All but one showed multiple drug resistance.

Multiple drug resistant untypable Salmonella typhimurium infection in children & neonates

Salmonella typhimurium infection in children and neonates is reported. Out of 21 cases, 6 were new-born and 13 were below one year of age. Clinical manifestations included fever, abdominal pain and diarrhoea. All the isolates were from stool, out of the total 21 cases, 4 expired. This study was done at Microbiology Department of Kasturba Medical College over a period of seven months.

Rapid slide haemagglutination test in urinary candidiasis

Quick diagnosis of urinary candidiasis was done by rapid slide haemagglutination test (SHA) and its efficacy was compared with countercurrent immunoelectrophoresis. This method was found to be much easier, less time consuming and an economical technique. Sera of 50 patients with urinary candidiasis were included for the present study and 50 control cases were also taken. The present study revealed that SHA test was more sensitive and specific than Countercurrent immunoelectrophoresis (the percentage of positive cases being 68% and 56% respectively).

The diversity of neurologic events in systemic lupus erythematosus. Prospective clinical and computed tomographic classification of 82 events in 71 patients

To investigate outcome and pathophysiology of central nervous system (CNS) systemic lupus erythematosus (SLE), we prospectively codified all cases of CNS SLE. Eighty-two events occurred in 71 patients. Four events in four patients were due to infection and were excluded. Twelve events occurred in 11 women with positive antinuclear antibody but negative anti-DNA antibody test reactions and no other manifestation of SLE. Of the remaining 66 events (56 patients), 26 events were "isolated" and 40 "complex." Non-CNS SLE was "active" during 47 events and "inactive" during 19 events. "Isolated" CNS events were equally likely in clinically "active" and "inactive" SLE. Patients with active SLE were as likely to have an episodic or remittent course as were patients with inactive SLE. "Complex" events, however, were more likely to have favorable outcome than were "isolated" events. "Isolated" events without focal CT abnormalities, the only component of CNS SLE that can be called diffuse lupus encephalitis, accounted for only 20% of all neurologic events.