Emergence of clinical isolates of highly carbapenem-resistant Klebsiella pneumoniae co-harboring blaNDM-5 and blaOXA-181 or -232 in Nepal.

OBJECTIVES: The aim of this study was to describe the emergence in Nepal of clinical isolates of Klebsiella pneumoniae harboring both blaNDM-5 and blaOXA-181/-232. METHODS: Six clinical isolates of K. pneumoniae highly resistant to carbapenems and aminoglycosides were obtained from inpatients in Nepal. Their whole genomes were sequenced by a next generation sequencer. RESULTS: The minimum inhibitory concentrations of meropenem, amikacin and ciprofloxacin were ≥128 µg/ml, >1024 µg/ml and ≥256 µg/ml, respectively. All six isolates co-harbored blaNDM-5, blaOXA-181 or -232 and rmtB. Of them, 1 also harbored rmtF. The blaNDM-5, blaOXA-232 and rmtB in all six isolates were located on plasmids. Of the six isolates tested, one isolate harbored two copies of blaOXA-181 and rmtF on the chromosome. CONCLUSIONS: This is the first report of clinical isolates of K. pneumoniae co-harboring blaNDM-5, blaOXA-181 or -232 and rmtB in Nepal. These strains were highly carbapenem- and aminoglycoside-resistant, and belonged to ST147 or ST395. Of them, ST147 isolate harbored two copies of blaOXA-181 on the chromosome.

Generalized aggressive periodontitis and its treatment options: case reports and review of the literature.

Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review.

Rare instance of gingival enlargement in Klippel-Trenaunay syndrome: a case report.

Klippel-Trenaunay Syndrome is a rare congenital malformation that may include port-wine stain, soft tissue and bony hypertrophy, and venous malformations and lymphatic abnormalities. Although it usually involves the limbs, it may also rarely involve the head, neck, and orofacial regions. Despite its rarity, Klippel-Trenaunay Syndrome should be considered in the differential diagnosis of gingival enlargement. The condition can be easily recognized clinically, but further investigations including imaging studies have to be carried out in order to better understand the nature of the lesion. This report describes a case of gingival enlargement in Klippel-Trenaunay Syndrome in a 16-year-old female patient. The diagnosis of the condition was made based on the patient history, clinical and radiographic examination, computed tomography (CT), and angiogram.

A case-control study on the association of human leukocyte antigen-A*9 and -B*15 alleles with generalized aggressive periodontitis in an Indian population.

BACKGROUND: The genes encoding the human leukocyte antigens (HLAs; major histocompatibility complex [MHC]) have been considered candidate markers for periodontitis because they are involved in regulating immune responses. Several studies have examined this association, and despite the inconclusive results, the antigens HLA-A9 and HLA-B15 have been found to be consistently associated with the destructive forms of periodontitis in many populations. Ethnic factors are considered to be a major variable for evaluating the predisposition to the disease. The purpose of the present study was to: 1) assess the association of HLA-A*9 and HLA-B*15 with generalized aggressive periodontitis (GAgP) and 2) evaluate the role of these genetic risk factors in influencing the severity of GAgP in a South Indian population. METHODS: Forty GAgP patients (cases) and 80 periodontally and systemically healthy subjects (controls) participated in this study. HLA-A*9 and HLA-B*15 typing was carried out using the polymerase chain reaction with sequence specific primers (PCR-SSP)-based molecular method. RESULTS: HLA-B*15 was a significant risk factor for GAgP and was positively correlated with the disease severity, whereas HLA-A*9 had no association with the disease. The haplotype of HLA-A*9:B*15 did not impart any additional risk for GAgP compared to that imparted by HLA-B*15 alone. CONCLUSIONS: To our knowledge, this is the first report on HLA-B*15 association with GAgP in an Indian population. The finding of HLA-B*15 as a risk factor may have potential use in the future management of GAgP. The precise disease-causing mechanism of this HLA disease association and whether this association is "causal" or "casual" need to be evaluated further.

Anterior esthetic gingival depigmentation and crown lengthening: report of a case.

Excessive gingival display space and gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. Melanin hyperpigmentation usually does not present a medical problem, but patients usually complain of dark gums as unaesthetic. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially rewarding in such individuals with compromised esthetics. A case is reported here on the cosmetic correction of "black gums" and "gummy smile." Periodontal plastic surgery combining gingival depigmentation and esthetic crown lengthening was performed in a single appointment using scalpel surgical technique. The outline of steps involved in the surgical procedure is demonstrated and a brief review of the various gingival depigmentation techniques is depicted here.