Post-transplant lymphoproliferative disorders of oral cavity

Post-transplant lymphoproliferative disorders (PTLD) are long-term complications of immunosuppression after solid organ/bone marrow transplantation. In most cases, PTLD arises as a result of primary or reactivated Epstein-Barr virus infection in a host with impaired cellular immunity. PTLD is most often seen in the gastrointestinal tract, although it has also been reported in other organ systems, including the central nervous system and, rarely, in the head and neck. It is characterized histologically by abnormal lymphoid cell proliferation. Although many forms of PTLD do not meet all of the histologic criteria of lymphoma, they often behave clinically in a malignant fashion if left untreated. We present 3 rare cases of PTLD manifesting in the oral cavity as mucosal masses after solid organ transplantation. There are only 8 published reports of PTLD in the literature presenting as oral lesions. The clinical, pathologic, and therapeutic spectra of PTLD are discussed.     

Colloid milium of the oral cavity: a rare presentation

Colloid milium (CM) is a rare condition characterized by the presence of multiple dome-shaped amber- or flesh-colored papules developing on sun-exposed skin. It is a degenerative condition linked to excessive sun exposure and possibly exposure to petroleum products and hydroquinone. The origin of the colloid deposition in the dermis is uncertain, although it is thought to be due to degeneration of elastic fibers. The condition is rare, with only 100 case reports documented in the world literature. The most commonly involved sites are the face, periorbital region, backs of the hands, back and sides of the neck, and ears. Involvement of the oral cavity is extremely rare. The purpose of this article is to report an extremely rare first case of CM of the oral cavity and to discuss the clinical, pathologic and therapeutic spectra of CM.     

Diabetes and driving

More than 69 million Indians are suffering from diabetes, of which a substantial proportion of the population are currently holding or will seek in the future the license to drive. Driving essentially requires multitasking with visuospatial skills at the same time and thus the management of diabetes in individuals which should demonstrate a proper detection and treatment of diabetes-related hypoglycemia will predict the capacity of driving any motor vehicle. Repeated hypoglycemia-related neuroglycopenia causes increased risk of neurocognitive dysfunction leading to visuospatial skills deficiency. Eight percent of dementia may be attributed to diabetes. Potential causes of driving impairment associated with diabetes are acute hypoglycemia, and its unawareness, retinopathy, neuropathy related to foot that affects ability to use pedals, IHD, cerebrovascular disease, somnolence and sleep disorder associated with obesity, use of pain relieving medications and antidepressant, and cognitive dysfunction and thus should be reviewed properly before issuing a driving license. Medical evaluation and documentation of acute and chronic complications of drivers by a registered medical practitioner at pre-determined intervals may be considered as a legal necessity to identify at-risk drivers. Secretagogues have a higher incidence of hypoglycemia compared to someone who is on metformin alone. On the other hand, hypoglycemia is more frequent in an insulin-treated patient of both type 1 and type 2 diabetes. In many countries as well as in European Union (EU), it is necessary to review medical fitness in every 3 years by the authority; a person should not have any severe hypoglycemic event in preceding 12 months and a driver must have awareness of hypoglycemia and its management. According to Canadian diabetes association consensus statement, review should be done every 2 years; a person should not have any severe hypoglycemic event in preceding 6 months, and according to ADA position statement evaluation should be done every 2–5 years. Medical fitness certificate should be reviewed at frequent intervals; the authorities should enforce strict regulation on suspension and revocation of driving license. Information to the authorities should be promptly done by doctors or patients. Decision should be based on medical evaluation, but hypoglycemia that occurs due to medication change and during sleep does not warrant for disqualification as it may be corrected with proper dietary changes and dose adjustments. Any driver with suspended license should be re-assessed in the next 6 months for their medical fitness and hypoglycemic profile and if found suitable, the license can be revoked. Physicians should participate and should assess patient’s physical and mental status, medical condition and treatment, list of medications which may impair driving performance, and any disease-related complication that lead to impaired driving or dangerous driving. Patient education is the most important factor to prevent any motor accident related to their medical condition and should be trained to prevent acute and chronic complications of diabetes.     

An observational study of the proceedings of the All India Ophthalmological Conference, 2000 and subsequent publication in indexed journals

AIMS: To determine the quality of reporting in the proceedings of the All India Ophthalmological Conference (AIOC) 2000, subsequent rate of publication in an indexed journal and differences between the proceedings and the journal version of these papers. DESIGN: Observational study. MATERIALS AND METHODS: All papers presented at the AIOC 2000 were retrieved from the proceedings and assessed for completeness of reporting. To determine the subsequent full publication, a Medline search was performed as of January 2007; consistency between the proceedings paper and the final publication was evaluated. Statistical analysis: Chi square and Fisher's exact tests were used to compare publication rates based on geographical location, subspecialty and study design; Student's t -test was used to compare differences based on the number of authors and sample size. RESULTS: Two hundred papers were retrieved; many failed to include study dates, design or statistical methods employed. Thirty-three (16.5%) papers were subsequently published in indexed journals by January 2007. The published version differed from the proceedings paper in 27 (81.8%) instances, mostly relating to changes in author name, number or sequence. CONCLUSIONS: The overall quality of reporting of scientific papers in the proceedings of the AIOC 2000 was inadequate and many did not result in publication in an indexed journal. Differences between the published paper in journals and in proceedings were seen in several instances. Ophthalmologists should be cautious about using the information provided in conference proceedings in their ophthalmic practice.     

Orbital amelanotic melanoma in xeroderma pigmentosum: a rare association

Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder of DNA repair in which the body's normal ability to repair damage caused by ultraviolet light is deficient. This leads to a 1000-fold increased risk of cutaneous and ocular neoplasms. Ocular neoplasms occurring in XP in order of frequency are squamous cell carcinoma, basal cell carcinoma and melanoma. Malignant melanomas occur at an early age in patients with XP. We report a case of XP with massive orbital melanoma in an eight-year-old boy which is unique due to its amelanotic presentation confirmed histopathologically.     

Nutritional quality evaluation of velvet bean seeds (Mucuna pruriens) exposed to gamma irradiation

Effects of gamma irradiation on Mucuna pruriens seeds at various doses (0, 2.5, 5, 7.5, 10, 15 and 30 kGy) on the proximate composition, mineral constituents, amino acids, fatty acids and functional properties were investigated. Gamma irradiation resulted in a significant increase of crude protein at all doses, while the crude lipid, crude fibre and ash showed a dose-dependent decrease. Raw Mucuna seeds were rich in minerals (potassium, phosphorus, calcium, magnesium, iron and selenium). Sodium, copper and manganese were significantly decreased on irradiation at all the doses, while magnesium and iron showed a significant decrease only above 10 kGy. The essential amino acids of raw and gamma-irradiated Mucuna seeds were comparable with the FAO/WHO recommended pattern. A significant increase of in vitro protein digestibility was seen in seeds irradiated at 30 kGy. High amounts of unsaturated fatty acids in Mucuna seeds decreased significantly after irradiation. However, linoleic acid was not present in raw seeds but detected after irradiation and it was elevated to high level at 30 kGy. Behenic acid, a major anti-nutritional factor, was reduced significantly on irradiation, indicating the positive effect of gamma irradiation on Mucuna seeds. Significant enhancement in the water absorption and oil absorption capacities, protein solubility, emulsion activity and improvement in the gelation capacity was recorded after irradiation. Results of the present investigation reveal that application of gamma irradiation does not affect the overall nutritional composition and can be used as an effective method of preservation of Mucuna seed and their products.