Primary Malignant Melanoma of Maxillary Gingiva

Malignant melanoma of maxillary gingiva is a rare clinical entity. Mucosal melanoma is more aggressive than cutaneous form and carries comparatively poorer prognosis. High index of suspicion is required for diagnosing malignant melanoma of oral cavity. Any pigmented lesion in the oral cavity should be taken seriously by the clinician.     

Ultrasound biomicroscopic characteristics of the anterior segment in primary congenital glaucoma

PURPOSE: To evaluate qualitatively and quantitatively ultrasound biomicroscopic (UBM) features of the anterior segment in eyes with primary congenital glaucoma. METHODS: UBM of 45 eyes of patients with primary congenital glaucoma (39 previously operated and 6 unoperated eyes) and 28 control eyes were included in this study. UBM parameters were correlated with ocular biometry. Iris thickness, ciliary body thickness, ciliary body-lens distance, posterior chamber depth, and anterior chamber angle were measured and compared with control eyes. Other features of the anterior segment were qualitatively evaluated. RESULTS: A thin, stretched-out ciliary body and abnormal tissue at the iridocorneal angle were features seen in 90% of UBM scans. Iris thickness and stretched zonules correlated with the axial length (r = -0.6 and 0.58, respectively; p = 0.04) but not with the mean corneal diameter. Abnormal insertion of the ciliary body to the posterior surface of the iris was noted in eight eyes (17%). CONCLUSIONS: The present study documents characteristic anterior segment dysplasia and ciliary body anomalies in patients with primary congenital glaucoma.     

Adverse drug event detection in a community hospital utilising computerised medication and laboratory data.

OBJECTIVE: Computerised monitors can detect and, with clinical intervention, often prevent or ameliorate adverse drug events (ADEs). We evaluated whether a computer-based alerting system was useful in a community hospital setting. METHODS: We evaluated 6 months of retrospectively collected medication and laboratory data from a 140-bed community hospital, and applied the rules from a computerised knowledge base to determine if the resulting alerts might have allowed a clinician to prevent or lessen harm related to medication toxicity. We randomly selected 11% (n = 58, of which 56 were available) of charts deemed to be high- or critical-priority alerts, based on the likelihood of the alerts being associated with injury, to determine the frequencies of ADEs and preventable ADEs. RESULTS: In 6 months, there were 8829 activations of the rule set, generating a total of 3547 alerts. Of these, 528 were of high or critical priority, 664 were of medium priority and 2355 were of low priority. Chart review among the sample (56 charts) of high- or critical-priority alerts found five non-preventable and two preventable ADEs, suggesting that among the total high- or critical-priority alerts alone, there would be approximately 94 non-preventable ADEs and 37 preventable ADEs annually in this hospital that could be detected using this method. CONCLUSIONS: Computer-based rules engines have the potential to identify and, with clinical intervention, mitigate preventable ADEs, and implementation is feasible in community hospitals without an advanced information technology application.     

Variation in content of taxol and related taxanes in Eastern Himalayan populations of Taxus wallichiana

Extraction and analysis of paclitaxel and other taxanes in bark, needle leaves and stem segments of male and female plants of Taxus wallichiana, representing several populations, indicate that significant variation in taxane content exists within the population. Bark accumulated maximum amount of paclitaxel in almost all plants. Populations located at higher altitude tended to accumulate more paclitaxel than lower altitude plants. Seasons in which samples were collected and plant age have also been shown to affect paclitaxel accumulation. No effects of plant sex on paclitaxel content of the plants analyzed were observed. Significant differences in baccatin-III and 10-deacetylbaccatin III content were found to exist in the trees analyzed in this study.     

Development of transferable skills during short special study modules: students' self-appraisal

Special study modules (SSMs) were introduced into the Leeds undergraduate medical curriculum following recommendations by the General Medical Council (GMC). The main rationale behind such project work is to enable students to develop the skills and attitudes necessary for future self-directed learning along with the knowledge required to practise as competent doctors. At the University of Leeds, the students complete SSM monitoring forms for each SSM in the fourth year, aimed at allowing students to self-evaluate the SSMs. In addition, it provides useful feedback from the students on the themes of the projects as well as on the transferable skills developed by the students during their individual SSMs. The aim of the study was to identify the themes pursued in each project, look at the transferable skills developed and evaluate the differences or similarities between the type of project pursued and the themes and skills identified in the different specialities. A total of 181 monitoring forms of fourth-year students were analysed for the themes and the transferable skills identified. There were 55 students each in Obstetrics and Gynaecology and Paediatrics and 50 students each in Psychiatry and General Practice/Public Health. The results from the four specialities were compared for themes and skills identified. Overall, health and prevention was the commonest theme identified followed by communication skills (64.4% and 62.7% respectively). All transferable skills were well represented in the different specialities with information gathering and learning/organizational skills identified by most students as the major component. The feedback from the students is positive in terms of a wide range of transferable skills developed and most of the themes identified by the GMC are being pursued.     

Depletion of norepinephrine decreases the proliferation,but does not influence the survival and differentiation,of granule cell progenitors in the adult rat hippocampus

The dentate gyrus region retains the ability to generate neurons throughout adulthood. A few studies have examined the neurotransmitter regulation of adult hippocampal neurogenesis and have shown that this process is regulated by serotonin and glutamate. Given the strong noradrenergic innervation of the adult hippocampus and the ability of norepinephrine to influence proliferation during development, we examined the influence of norepinephrine on adult hippocampal neurogenesis. Our study indicates that depletion of norepinephrine by the selective noradrenergic neurotoxin, N-(2-chloroethyl)-N-ethyl-2-bromo benzylamine hydrochloride (DSP-4), results in a 63% reduction in the proliferation of dentate gyrus progenitor cells identified through 5-bromo-2'-deoxyuridine (BrdU) labelling. In contrast, the survival of BrdU-positive cells labelled prior to treatment with DSP-4 is not influenced by norepinephrine depletion. The differentiation of BrdU labelled progenitors into neurons or glia was also not sensitive to noradrenergic depletion. These results indicate that the proliferation, but not the survival or differentiation, of adult hippocampal granule cell progenitors is affected by norepinephrine depletion.     

Pitfalls in diagnosis of epilepsy of Janz and its implications

84 patients of juvenile myoclonic epilepsy (JME) of Janz were studied. Diagnosis was confirmed using clinical and electro-encephalographic (EEG) criterias. 58 (78%) patients of JME were referred as 'refractory or uncontrolled seizures'. Ignoring myoclonic episodes and non-use of activation procedures in EEG were important reasons for diagnostic delay. Sodium valproate (VPA) or clonazepam are the drugs of choice while phenobarbitone (PB), carbamazepine (CZ), and phenytoin (PHT) are ineffective. Clinical spectrum of JME is slightly different in India. Family history of epilepsy or JME is not forthcoming and there is gross delay in the diagnosis. Other differences include age of presentation and mild cognitive impairment. All juvenile patients of generalized epilepsy, not responding to more commonly used CZ, PB and PHT should be strongly suspected for JME by carefully searching for myoclonus.     

Clinical usefulness of telomerase activation and telomere length in head and neck cancer

BACKGROUND: Telomere shortening at every replication cycle is postulated to limit the life span of human somatic cells. In contrast, activation of telomerase is proposed to be an essential step for cancer cell immortalization. Head and neck cancer is the most common malignancy in the Indian population compared with Western countries. However, there are very few reports on telomerase activity and telomere length in head and neck cancer. METHODS: Telomerase activation and telomere length alterations were studied in tumor and adjacent normal tissues in 110 patients with head and neck cancer and 40 patients with precancerous/benign conditions. Telomerase activity and telomere lengths were determined by Telomeric Repeat Amplification Protocol (TRAP assay) and Southern blot analysis, respectively. RESULTS: Telomerase activation was observed in 78.2% of the malignant tissues, 85% of the precancerous tissues, and 53.1% of the adjacent normal tissues. Peak terminal restriction fragment length (TRF) was observed to be significantly lower in malignant tissues compared with the adjacent normal tissues. No significant correlation could be observed between telomerase activation and clinicopathologic characteristics of the patients. Two-year disease-free survival analysis showed that patients showing telomerase activation in the adjacent normal tissues and patients showing higher telomere length in malignant tissues had poor disease-free survival. CONCLUSIONS: Our results demonstrate the significant clinical usefulness of telomerase activation and telomere length for head and neck cancer patients. These markers may be helpful in predicting the clinical course of the disease and thus in identifying the patients in need of a close follow-up and vigorous adjuvant treatment.