Effectiveness of metronidazole gel and mobile telephone short-message service reminders on gingivitis in orthodontic patients:: A double-blind randomized controlled trial

ObjectivesTo compare the effectiveness of metronidazole gel and mobile telephone short-message service (SMS) reminders on gingivitis in patients undergoing fixed orthodontic treatment.Materials and MethodsThe trial was double blinded (patient and investigator), and only the clinical trial unit pharmacist was unblinded. Data were collected from patients undergoing fixed orthodontic treatment for at least 6 months. A total of 66 patients were randomly assigned to either 0.8% metronidazole gel (n = 22), SMS reminder and placebo gel (n = 22), or placebo (control) group only (n = 22). Gingival index (GI), bleeding index (BI), and orthodontic plaque index (OPI) were evaluated on several teeth at baseline (T₀) and after 4 weeks (T₁). Paired-sample t-tests were used to compare mean differences of indexes at T₀ and T₁ in the groups, and independent-sample t-tests were used to determine the effects of interventions compared with the controls.ResultsData from 64 patients were analyzed; there were 2 dropouts. There were statistically significant (P < .05) reductions in GI, BI, and OPI scores from T₀ to T₁ for each intervention. However, there were no significant differences between each intervention and the control group. There were no adverse effects.ConclusionsThe null hypothesis could not be rejected. There is no difference between interventions (application of 0.8% metronidazole gel and SMS reminder for reinforcing oral hygiene) in reducing gingival inflammation in orthodontic patients.     

Two novel TP63 mutations associated with the ankyloblepharon, ectodermal defects, and cleft lip and palate syndrome: a skin fragility phenotype

BACKGROUND: Ankyloblepharon, ectodermal defects, and cleft lip and palate (AEC) syndrome is a rare autosomal dominant disorder caused by mutations in the sterile alpha motif region of TP63, a homologue of the tumor suppressor TP53. Recent structure-function studies have identified complexities in the genotype-phenotype correlation of the p63 syndromes. OBSERVATIONS: We report 2 sporadic cases of AEC syndrome in infants. Both patients demonstrated skin erosions with prominent scalp involvement. Histologic studies demonstrated mild basal layer vacuolization and rare dyskeratotic keratinocytes, with evidence of both acantholysis and cytolysis at the blister edge. Immunohistochemistry using anti-p63 monoclonal antibody demonstrated basal epidermal nuclear staining in both healthy control and patient tissue samples. Ultrastructural studies showed focal disruption of anchoring fibrils near the blister edge of one patient and normal desmosomes, hemidesmosomes, and basement membrane zone in the nonblistered skin of the other patient. The DNA analysis of each patient revealed 2 novel missense mutations in the TP63 gene that resulted in L514S and R555P amino acid substitutions within the sterile alpha motif region of the p63 protein. CONCLUSIONS: We report 2 novel TP63 mutations resulting in AEC syndrome. The R555P mutation is the most carboxy-terminal of all the reported AEC missense mutations of p63. The presence of skin fragility, manifested as erosive skin lesions in body areas in addition to the scalp, is postulated to be an important diagnostic feature of AEC syndrome.     

COMPARISON OF DIFFERENT PHENOTYPIC METHODS OF DETECTION OF METHICILLIN RESISTANCE IN Staphylococcus aureus WITH THE MOLECULAR DETECTION OF mec-A GENE

Objective: To evaluate accuracy, cost-effectiveness and ease to perform different phenotypic methods i.e. Cefoxitin 30 microg disc, Oxacillin 1microg disc and Oxacillin agar screening plate (6microg/ml ) for early and accurate identification of MRSA by comparing with the detection of mec-A gene in our clinical isolates. Design: A comparative study. Place and Duration of Study: Clinical samples submitted in the Clinical Microbiology Laboratory at Aga Khan University Hospital, Karachi, from 1st August to 31st October 2006. Material and Methods: Out of 200 clinical samples, conventional Polymerase chain reaction (PCR) was done on 62 pure biochemically identified S. aureus isolates for mec-A gene detection. Phenotypic methods for detecting methicillin sensitivity (Cefoxitin 30 microg disc, Oxacillin 1 microg disc and Oxacillin agar screening plate) were also used according to the recommended incubation time, duration and temperature on the same isolates. Results: Out of 62 isolates of S. aureus, mec-A gene were detected (MRSA) in 32, whereas 30 were mec-A gene negative (MSSA). Cefoxitin disc and agar screening plate correctly identify all MRSA isolates with the sensitivity and specificity of 100%. Single isolate was false, positively detected as sensitive with Oxacillin 1microg disc, due to which, the sensitivity and negative predictive value of this method were reduced to 96.9% and 96.8% respectively, while positive predictive value and specificity remained 100%. Conclusion: Comparing different phenotypic methods for MRSA screening in routine microbiology laboratory, Cefoxitin disc and Oxacillin agar screening has better sensitivity and specificity comparative to Oxacillin disc. However, Cefoxitin disc can be preferred especially for small laboratories because it is easy to perform, do not require special technique and media preparation is consequently more cost-effective.     

Emergence of quinolone-resistant Neisseria gonorrhoeae in Pakistan

Quinolone-resistant Neisseria gonorrhoeae (QRNG) have not been reported from Pakistan to date. This is the first report of the presence of QRNG in Pakistan. The study was performed at a tertiary care hospital laboratory in Karachi, Pakistan. Antimicrobial susceptibility data on all N. gonorrhoeae isolated between 1992 and 2002 were retrieved and analysed. Minimum inhibitory concentrations (MICs) of QRNG isolated in year 2002 were performed, and clinical information was collected. QRNG was first noted in 1999 and its proportion increased to 42% in 2002. MICs of the 12 isolates tested in 2002 showed a high level of resistance to ofloxacin with MIC of more than 4 microg/mL. Clinical information from patients with QRNG showed treatment failure. Emergence of QRNG in developing countries is alarming as there is no proper surveillance of increase in resistance. We strongly urge the need of detection and documentation of the resistant gonococcal isolates, as in vitro resistance is associated with clinical failure.     

Carnitine deficiency with cardiomyopathy presenting as neonatal hydrops: Successful response to carnitine therapy

Summary A small-for-date infant presented at birth with severe non-immune hydrops, cardiac failure, metabolic acidosis and hypoglycaemia. Ultrasonography disclosed a cardiomyopathy. Initial therapy consisting of artificial ventilation, inotropes and diuretics resulted in partial disappearance of oedema without significant improvement in cardiac function. Episodes of hypoglycaemia recurred despite continuous glucose influsions.Total serum carnitine from cord blood was 1.65 nmoles/ml and was undetectable on day 20. Oraldl-carnitine supplements resulted in normoglycaemia, dramatic improvement in cardiac function and restoration of serum carnitine levels to normal values. The infant was thereafter maintained on carnitine therapy. Follow-up over 1 year showed moderate growth retardation and normal developmental milestones.In order to account for such a severe neonatal presentation of carnitine deficiency, a combination of defective pre- and postnatal carnitine supply with an inborn error of carnitine handling is considered. The present case illustrates the need for evaluation of carnitine status in fetuses and neonates presenting with hydrops associated with cardiac failure.     

Acute toxicity studies of a novel excipient arabinoxylan isolated from Ispaghula (Plantago ovata) husk

Purpose: The arabinoxylan from Ispaghula (Plantago ovata) husk has been proven scientifically as potential excipient. However, toxicity study of the arabinoxylan is still lacking. The present study was done to investigate the acute toxicity of arabinoxylan in two animal species. Methods: The mice were exposed to (1?g/kg, 5?g/kg, 10?g/kg) and rabbits (2.5?g/kg, 5?g/kg) of arabinoxylan orally and observed for a period of 14 days. On day 15 hematology, serum biochemistry and necropsy was performed in mice relative organ weight calculated and histological examination was carried out. Primary dermal and eye irritation tests were carried out. Cardiac effects of isolated arabinoxylan were studied on frog heart. Results: The acute administration of the arabinoxylan did not produce mortality or significant changes in, water and food consumption however body weights of mice and rabbits decreased initially with a gradual increase till day 14. Internal organs relative weights were found to be normal. Hematological biochemical and histopathological examination did not show any significant (p?Conclusion: This study has shown that acute administration of arabinoxylan may be safe.