Preliminary Impressions in Microstomia Patients: An Innovative Technique

Microstomia has been defined as an abnormally small oral orifice associated with various etiopathologic factors. Management of these patients poses extreme difficulties in every procedure during prosthesis fabrication. Restricted mouth opening of the patient makes the insertion and the removal of the tray extremely difficult. So sectioning of the existing stock tray is necessary, so that the trays can be inserted and removed in sections. The main problem encountered during this procedure is the reorientation of the tray back in position. This article presents an innovative technique for the easy handling of the sectioned stock impression trays.     

Fulminant intracranial hypertension due to cryptococcal meningitis in a child with nephrotic syndrome

Cryptococcus neoformans has a worldwide distribution. Meningoencephalitis is the most common manifestation of cryptococcosis. The outcome of a patient with cryptococcal infection depends on the immune status of the host. Patients with nephrotic syndrome are particularly susceptible to cryptococcal infection not only due to innate changes in their immune system but also because of the immunosuppressive agents used in the treatment. We report an 8-year-old boy with nephrotic syndrome, who developed cryptococcal meningitis and died of fulminant intracranial hypertension.     

Large pulmonary cryptococcoma and cryptococcal meningitis in an immunocompetent patient: A case report

Pulmonary cryptococcoma is a life threatening mycosis and is an unusual disease for immunocompetent individuals. Herein we report a case of large pulmonary cryptococcoma associated with cryptococcal meningitis, presenting radiologically as a lung mass in right upper lobe, in a previously healthy, HIV negative, immunocompetent young individual. Since cryptococcosis continues to be an important infection in HIV negative patients and is associated with substantial overall and cause‐specific mortality, the need for consideration of this entity in the differential diagnosis of a lung mass is emphasized. Diagn. Cytopathol. 2010;38:929–931. © 2010 Wiley‐Liss, Inc.     

Indirect Magnetic Resonance Arthrography May Help Avoid Second Look Arthroscopy for Assessment of Healing After Bucket Handle Medial Meniscus Repairs: A Prospective Clinico-Radiological Observational Study

ObjectivesThe objectives were: (1) to analyze the MRI healing rates of bucket-handle meniscus repair; (2) to compare the accuracy of assessment of meniscus healing for conventional MRI and Indirect Magnetic Resonance Arthrography (IMRA); and (3) to identify patients who may require second-look arthroscopy after meniscus repair.MethodsThis is a prospective observational case series of thirty-seven patients with repaired bucket-handle medial meniscus tear with a minimum one year follow-up. Meniscus healing rates were assessed on direct MRI and IMRA using Henning’s criteria. At the same time, patients’ symptoms were evaluated according to Barrett’s criteria and functional outcomes were recorded using International Knee Documentation Committee (IKDC) score, Knee Osteoarthritis and Outcomes Score (KOOS) and Tegner–Lysholm scores. A further clinical review was performed 18 months after the imaging to assess the evolution of symptoms.ResultsAt a mean of 22.3 ± 7.8 months after the meniscus repair, 56.7% patients showed complete healing and 40.5% patients demonstrated incomplete repair healing on IMRA. 52% patients with complete healing and 40% patients with incomplete healing demonstrated meniscus symptoms. At the second clinical review, 19% patients with complete healing and 20% patients with incomplete healing had meniscus symptoms. There was no co-relation between symptoms, PROMs and healing on MRI.ConclusionIndirect MR arthrography offers distinct advantages over direct MRI for assessment of meniscus healing, especially in symptomatic patients. Patient-reported outcome measures and symptomatology are not co-related with the healing status of the meniscus and they resolve in the majority on longer follow-up. A more conservative approach guided by IMRA to assess meniscus healing will avoid early re-operations.     

Prenatal,perinatal and neonatal risk factors of Autism Spectrum Disorder: A comprehensive epidemiological assessment from India

Incidence of Autism Spectrum Disorder (ASD) is increasing across the globe and no data is available from India regarding the risk factors of ASD. In this regard a questionnaire based epidemiological assessment was carried out on prenatal, perinatal and neonatal risk factors of ASD across 8 cities in India. A retrospective cohort of 942 children was enrolled for the study. 471 children with ASD, under age of 10, were analyzed for pre-, peri-, and neonatal factors and were compared with the observations from equal number of controls. The quality control of the questionnaire and data collection was done thoroughly and the observations were computed statistically. A total of 25 factors were evaluated by unadjusted and adjusted analysis in this study. Among the prenatal factors considered, advanced maternal age, fetal distress and gestational respiratory infections were found to be associated with ASD and had an odds ratio of 1.8. Evaluation of perinatal and neonatal risk factors showed labor complications, pre-term birth, neonatal jaundice, delayed birth cry and birth asphyxia to be associated with ASD with an odds ratio greater than 1.5. This important study, first of its kind in Indian population gives a firsthand account of the relation of pre-, peri- and neonatal risk factors on ASD from an ethnically and socially diverse country like India, the impact of which was unknown earlier. This advocates additional focused investigations on physiological and genetic changes contributed by these risk factor inducing environments.     

Radioprotection by copper and zinc complexes of 5-aminosalicylic acid: a preliminary study.

The effect of copper and zinc complexes of 5-aminosalicylic acid (hereafter referred to as Cu-5ASA and Zn-5ASA, respectively) against whole-body gamma radiation-induced cytotoxicity was studied in Swiss albino mice. Protection against lethal irradiation was evaluated from 30 day mouse survival (10 Gy) and endogenous spleen colony assay (11 Gy); and against sublethal dose (4 Gy) was assessed from gamma irradiation (RT)-induced formation of micronuclei in the mouse bone marrow 24 h postirradiation. Pretreatment with either Cu-5ASA (2.5-9 mg/kg) or Zn-5ASA (3.5-14 mg/kg) intraperitoneally (i.p.) delayed and reduced percentage mortality in mice exposed to 10 Gy RT. The doses 9 mg/kg for Cu-5ASA and 7 mg/kg for Zn-5ASA were found to be the most effective dose in preventing RT-induced weight loss and reducing percentage mortality. Both the drugs also caused an increase in the endogenous spleen colonies in mouse exposed to 11 Gy RT. At sublethal doses of RT, pretreatment with either Cu-5ASA or Zn-5ASA resulted in a significant decrease in the RT-induced micronucleated polychromatic erythrocytes and normochromatic erythrocytes (MPCEs and MNCEs) and an increase in the ratio of PCE to NCE (P/N), at 24 h postirradiation. These results show that both Cu-5ASA and Zn-5ASA are effective in protecting normal tissues against lethal and sublethal doses of RT. Further pretreatment with either Cu-5ASA or Zn-5ASA enhanced the survival of tumor-bearing mice (Ehrlich's ascites carcinoma) exposed to 7.5 Gy RT. In fact, both the complexes caused an increase in the mean and average survival times (MST and AST) when compared to the irradiated control, suggesting a synergetic effect of these drugs with radiation in causing cytotoxicity to the tumor cells. The data clearly indicate that both Cu-5ASA and Zn-5ASA significantly reduced the deleterious effect of radiation and hence could be useful agents in reducing the side effects of therapeutic radiation.     

Gender and status asthmaticus.

BACKGROUND: Adult women may be more susceptible to asthma than men. HYPOTHESIS: Women are more likely to develop status asthmaticus (SA) requiring critical care. METHODS: The medical records of patients admitted to our medical intensive care unit (ICU) for SA between 1994 and 2000 were examined. A number of demographic and physiologic variables were extracted from the medical records. RESULTS: Of 103 total admissions, 53 (of 37 patients) were age < 50 years and had clinical evidence suggesting SA. Among these 37 patients, the average (+/-SE) age was 30.8 +/- 1.0 y with average acute physiology and chronic health evaluation (APACHE) II of 9.5 +/- 0.8. Seventeen patients were Hispanic, 13 were black, and 7 were white. Twenty-four patients (accounting for 37 admissions) were female and 13 patients (16 admissions) were male. Although women accounted for a greater absolute number of endotracheal intubations (ETI; 17 vs. 12) and were more likely to be admitted to ICU more than once (7 vs. 3), men had a higher incidence of ETI (RR=1.6; 95%CI=1.04-2.6). The need for using therapeutic permissive hypercapnia and lengths of stay (ventilator, ICU, and hospital) were similar between men and women. Two patients, both women, died of causes not related to treatment of SA. CONCLUSIONS: These data suggest that although women accounted for more ICU admissions for SA, men were more likely to require ETI.