Progressive multifocal leukoencephalopathy in autoimmune diseases

Progressive multifocal leukoencephalopathy (PML) is a subacute central nervous system infection due to reactivation of the JC virus. Most reported cases occurred in HIV-infected patients (80% of cases), patients with lymphoid malignancies (13%) and transplant recipients taking immunosuppressants (5%). Less often, PML has been described in patients with chronic inflammatory joint diseases associated with autoimmune disorders (lupus, rheumatoid arthritis [RA] and vasculitis) (2%). Magnetic resonance imaging of the brain shows suggestive changes and confirmation of the diagnosis is obtained by performing PCR tests to identify the JC virus in the cerebrospinal fluid or, when necessary, a brain biopsy. No treatments have been proven effective. Most patients experience progressive disease that is fatal within a few months or induces incapacitating neurological impairments. The risk of PML is 0.4/100 000 in patients with RA. In the few case-reports of PML in RA patients, the treatments used included methotrexate (five cases) combined with a biological agent such as infliximab (one case), rituximab (four cases), or leflunomide (two cases including one with concomitant rituximab). PML is an extremely rare but devastating complication. Rituximab therapy is associated with an increased prevalence of PML in RA patients (4/100 000), who should be informed of this risk. In patients with lupus, the risk of PML is higher than in RA (4/100 000) and 40% of cases of PML occur during low-dose glucocorticoid therapy without immunosuppressive therapy.     

Determination of Fluoride in Tap Water in Morocco using a Direct Electrochemical Method

This study aimed to analyze the fluoride concentration in tap drinking water in different cities of Morocco using an electrochemical ion-selective method. Three samples were collected from each thirteen selected cities in the period between March and May 2011. The median value of fluoride was 0.94 mg/L (0.21–2.97). High fluoride concentrations (>0.8 mg/L) were found in sixteen cities. Very high values were found in phosphate regions such as Khouribga which is known to be an endemic dental fluorosis area. This study has shown that the concentration of fluoride in drinking water exceeds the limit especially in phosphate regions.     

Tonsil and adenoid surgery for upper airway obstruction in children.

We studied the outcomes of 76 children, aged 3 to 12 years, with large tonsils and/or large adenoids who underwent surgery to relieve upper airway obstruction over a 1-year period. Following surgery, nearly all patients experienced an alleviation of all symptoms, except for enuresis. We suggest that children who have large tonsils and/or adenoids will gain substantial benefit if they are removed, even children who do not have a history of severe sleep apnea or objective evidence from polysomnography.     

Cyclosporine-induced gingival overgrowth in beagle dogs

Development of gingival overgrowth during daily long-term cyclosporine A treatment was studied in 2-yr-old beagles. Gingival enlargement developed in five of 12 dogs (42%), primarily in the mandibular anterior area. The earliest gingival changes occurred by 3 wk as an increase in the size of the interdental papillae. The lesions progressively became more severe, in some cases obscuring portions of teeth by wk 6. The redundant tissue exhibited an increase in connective tissue components and an inflammatory infiltrate primarily of plasma cells. Severity of the overgrowth varied in responding animals; both incidence and severity were related to the CSA concentration in blood. The mean CSA blood levels of responders were significantly greater than nonresponders at wk 3, 6 and 10. Since beagles develop gingival overgrowth similar to humans, they provide an excellent model to investigate the roles of local and systemic factors in the induction of gingival overgrowth.