Mucosal Melanoma of Palate: A Case Report with Review of Literature.

The World Health Organisation defines mucosal malignant melanoma as a malignant tumour of melanocytes or of melanocyte progenitors. Due to the lack of symptoms and unknown etiology, mucosal malignant melanoma may go undiagnosed. The surgeon can find it challenging to come up with a definitive treatment strategy because of its rarity and rapid spread. In this case study, a 57-year-old female patient with hyperpigmented gingiva and palate diagnosed pathologically and immunohistochemically as malignant melanoma underwent surgical excision and a modified radical neck dissection.

Dietary fat lowers ileal endogenous amino acid losses in broiler chickens.

1. An experiment was conducted to determine the effect of the source of fat (soybean oil or tallow) on the ileal endogenous amino acid (EAA) losses in broilers.2. Three nitrogen (N)-free diets; a control diet with no added fat and test diets with 60 g/kg of either soybean oil or tallow were formulated. Titanium dioxide (5 g/kg) was added to all diets as an indigestible marker. Each diet was assigned to six replicate cages (eight birds per cage) from d 18 to 21 post-hatch. On d 21, the digesta were collected from the lower half of the ileum.3. The endogenous losses of nitrogen and amino acids (AA) were lower (p = 0.08; p = 0.001) in broilers fed diets with soybean oil or tallow, respectively, compared to those fed the diet with no fat. Source of fat had no influence (p > 0.05) on EAA losses.4. The most abundant AA in the ileal endogenous protein was glutamic acid, followed by aspartic acid, threonine, leucine, serine, valine and proline. In general, the concentrations of AA in the endogenous protein were lower (p < 0.05) with added fat. The exceptions were methionine, cysteine, proline and serine, which were unaffected. The effect of fat source on the AA contents of endogenous protein were inconsistent and differed depending on the AA.5. The inclusion of fats decreased EAA losses which implied they have beneficial effects beyond direct energy contribution. It can be proposed that the reduction of EAA flow may be an additional mechanism contributing to the extra-caloric effect of dietary fats.

Influence of high dose of phytase and an emulsifier on performance, apparent metabolisable energy and nitrogen retention in broilers fed on diets containing soy oil or tallow.

The effects of high dose of microbial phytase and an emulsifier on the performance, apparent metabolisable energy (AME) and nitrogen (N) retention in broilers fed on diets containing different fat sources were examined in a 5-week trial. Two fat sources (soy oil and tallow), two inclusion levels of E. coli phytase (500 or 1000 phytase units (FTU)/kg diet) and two inclusion levels of lysolecithin emulsifier (0 or 3.5 g/kg of diet) were evaluated in a 2 × 2 × 2 factorial arrangement of treatments. Throughout the 5-week trial, soy oil supplementation improved weight gain and feed per gain compared with tallow, but had no effect on feed intake. The high dose of phytase increased the weight gain and feed intake and lowered the feed per gain during d 1-21, but had no effect on performance parameters over the whole trial period. An effect of emulsifier was observed for feed intake during d 1-21 and over the whole trial period. Addition of emulsifier increased feed intake compared with diets without emulsifier. During weeks 1, 2, 3 and 5, birds fed on soy oil-based diets had higher nitrogen-corrected AME (AMEN) compared with those fed on tallow-based diets. During weeks 2, 3 and 5, the effect of phytase was significant for AMEN, with the high dose increasing the AMEN. During week 2, AMEN was increased with emulsifier addition. During weeks 1, 2, 3 and 5, birds fed on soy oil-based diets had higher fat retention compared with those fed on tallow-based diets. The high dose of phytase improved the retention of fat during week 5 and the addition of emulsifier resulted in higher fat retention during week 1. During weeks 2, 3 and 5, an interaction between fat source × phytase × emulsifier was observed for N retention. In soy oil-based diets, emulsifier plus 1000 FTU/kg phytase increased N retention compared with other groups, while in tallow-based diets, emulsifier addition increased N retention in diets with 500 FTU/kg, but not in 1000 FTU/kg diet. Overall, the present data suggest that the dietary fat source influenced performance, AMEN and fat retention in broiler chickens. There is opportunity to improve bird performance during d 1-21, AMEN and fat retention with higher doses of microbial phytase. Addition of the emulsifier increased the AMEN during week 2 and tract retention of fat during week 1, but this effect was not translated into improvements in performance.

Effect of coccidia challenge and natural betaine supplementation on performance, nutrient utilization, and intestinal lesion scores of broiler chickens fed suboptimal level of dietary methionine.

The aim of the present experiment was to examine the effect of coccidia challenge and natural betaine supplementation on performance, nutrient utilization, and intestinal lesion scores of broiler chickens fed suboptimal level of dietary methionine. The experimental design was a 2×2 factorial arrangement of treatments evaluating two levels of betaine supplementation (0 and 960 g betaine/t of feed) without or with coccidia challenge. Each treatment was fed to 8 cages of 8 male broilers (Ross 308) for 1 to 21d. On d 14, birds in the 2 challenged groups received mixed inocula of Eimeria species from a recent field isolate, containing approximately 180,000 E. acervulina, 6,000 E. maxima, and 18,000 E. tenella oocysts. At 21d, digesta from the terminal ileum was collected for the determination of dry matter, energy, nitrogen, amino acids, starch, fat, and ash digestibilities. Lesion scores in the different segments of the small intestine were also measured on d 21. Performance and nutrient digestibility data were analyzed by two-way ANOVA. Lesion score data were analyzed using Pearson chi-square test to identify significant differences between treatments. Orthogonal polynomial contrasts were used to assess the significance of linear or quadratic models to describe the response in the dependent variable to total lesion scores. Coccidia challenge reduced (P<0.0001) the weight gain and feed intake, and increased (P<0.0001) the feed conversion ratio. Betaine supplementation had no effect (P>0.05) on the weight gain or feed intake, but lowered (P<0.05) the feed conversion ratio. No interaction (P>0.05) between coccidia challenge and betaine supplementation was observed for performance parameters. Betaine supplementation increased (P<0.05) the digestibility of dry matter, nitrogen, energy, fat, and amino acids only in birds challenged with coccidia as indicated by the significant interaction (P<0.0001) between betaine supplementation and coccidia challenge. The main effect of coccidia challenge reduced (P<0.05) starch digestibility. Betaine supplementation improved (P<0.05) starch digestibility regardless of the coccidia challenge. For each unit increase in the total lesion score, there was a linear (P<0.001) decrease in digestibility of mean amino acids, starch, and fat by 3.8, 3.4 and 16%, respectively. Increasing total lesion scores resulted in a quadratic (P<0.05) decrease in dry matter digestibility and ileal digestible energy. No lesions were found in the intestine or ceca of the unchallenged treatments. In the challenged treatments, betaine supplementation reduced (P<0.01) the lesion scores at the duodenum, lower jejunum, and total lesion scores compared to the treatment without supplements. In conclusion, coccidia challenge lowered the digestibility of energy and nutrients and increased the feed conversion ratio of broilers. However, betaine supplementation reduced the impact of coccidia challenge and positively affected nutrient digestibility and the feed conversion ratio.

The impact of mandatory helmet law on the outcome of maxillo facial trauma: a comparative study in kerala.

INTRODUCTION: Motorcyclists comprise the majority of road-traffic victims in low and middle income countries,and consequently, the majority of the road-traffic victims globally. Simple measures can be taken to make safer on the roads, which include enforcement of safety measures like seat belt and helmets. The compulsory Helmet law was enforced in Kerala on 18/06/07. Resistance to legislation on motorcycle helmets still coexists world wide with debate on the effectiveness of helmets. In an attempt to analyze the protective effect of helmets on facial injuries a comparative study was conducted in Government Dental College, Calicut, which is a major trauma centre in northern Kerala. METHODS: Data for the present study was obtained from the patients who have reported to the Emergency Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, for a period of 6 months immediately after the implementation of strict helmet rule in Kerala. For the study all patients with a history of nonfatal motor cycle accident sustaining facial injuries were included. The results were compared with the study conducted in the same institution in the pre law period. RESULTS: The study demonstrates the protective effect of motorcycle helmets in decreasing the morbidity of maxillofacial trauma.There was a marked decrease in incidence of motorcycle-related injuries, remarkable increase in helmet usage and better outcome in helmeted individuals in the post law period. CONCLUSION: Road traffic injury control is a public health problem. Health and medical professionals have an ethical responsibility to educate and arrange for the safety of individuals. Helmets are effective in preventing or reducing the severity of motorcycle-related injuries and in a developing country like India, enforced mandatory motor cycle helmet law is potentially one of the most cost effective interventions available.

Digital gangrene in a patient with primary Raynaud's phenomenon.

Digital gangrene is not usually associated with primary Raynaud's phenomenon (RP). Its presence should therefore alert the healthcare provider to look for an alternative explanation. A 19-year-old female patient with primary RP developed digital gangrene following surgical management of acute paronychia. The possible mechanism in this patient appears to be the augmentation of the vasoconstrictive response due to the local infiltration of epinephrine mixed with lignocaine prior to the incision and drainage of her infected finger.

Protein-phytate interactions in pig and poultry nutrition: a reappraisal.

Protein-phytate interactions are fundamental to the detrimental impact of phytate on protein/amino acid availability. The inclusion of exogenous phytase in pig and poultry diets degrades phytate to more innocuous esters and attenuates these negative influences. The objective of the present review is to reappraise the underlying mechanisms of these interactions and reassess their implications in pig and poultry nutrition. Protein digestion appears to be impeded by phytate in the following manner. Binary protein-phytate complexes are formed at pH levels less than the isoelectric point of proteins and complexed proteins are refractory to pepsin digestion. Once the protein isoelectric points are exceeded binary complexes dissociate; however, the isoelectric point of proteins in cereal grains may be sufficiently high to permit these complexes to persist in the small intestine. Ternary protein-phytate complexes are formed at pH levels above the isoelectric point of proteins where a cationic bridge links the protein and phytate moieties. The molecular weights of protein and polypeptides in small-intestinal digesta may be sufficient to allow phytate to bind nutritionally important amounts of protein in ternary complexes. Thus binary and ternary complexes may impede protein digestion and amino acid absorption in the small intestine. Alternatively, phytate may interact with protein indirectly. Myo-inositol hexaphosphate possesses six phosphate anionic moieties (HPO(4)(2-)) that have strong kosmotropic effects and can stabilise proteins by interacting with the surrounding water medium. Phytate increases mucin secretions into the gut, which increases endogenous amino acid flows as the protein component of mucin remains largely undigested. Phytate promotes the transition of Na(+) into the small-intestinal lumen and this suggests that phytate may interfere with glucose and amino acid absorption by compromising Na(+)-dependent transport systems and the activity of the Na pump (Na(+)-K(+)-ATPase). Starch digestion may be depressed by phytate interacting with proteins that are closely associated with starch in the endosperm of cereal grains. While elucidation is required, the impacts of dietary phytate and exogenous phytase on the site, rate and synchrony of glucose and amino acid intestinal uptakes may be of importance to efficient protein deposition. Somewhat paradoxically, the responses to phytase in the majority of amino acid digestibility assays in pigs and poultry are equivocal. A brief consideration of the probable reasons for these inconclusive outcomes is included in this reappraisal.

Metaanalysis of maxillofacial trauma in the northern districts of kerala: one year prospective study.

PURPOSE: There is an increased incidence of maxillofacial trauma all over the world. A study was conducted to find out the epidemiological characteristics of maxillofacial trauma in Northern districts of Kerala. METHODS: All the trauma patients who attended the Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, Kerala during the period of 2006-2007 was included in the study. The incidence, prevalence, age and sex distribution, seasonal and daily variations and aetiology of maxillofacial trauma were studied. The pattern and demographic distribution of fractures of maxillofacial skeleton also were studied. RESULTS: This study indicates a significant increase in the incidence of maxillofacial trauma in the region. There was a male predominance and the highest incidence was in the age group of 20-40 years. Road traffic accident was the most common aetiological factor causing maxillofacial trauma. More than 30% of trauma cases suffered fracture of maxillofacial skeleton. There was an increased incidence of midface fracture when compared to mandibular fractures in the study. Most common site of mandibular fracture was in the parasymphysis region and in the midface was the zygomatic complex region. CONCLUSION: The increased incidence of maxillofacial trauma following road traffic accidents noted in this study reveals the need for formulating preventive measures in the state of Kerala. Increasing facilities for the management of maxillofacial trauma at local hospitals and medical colleges is mandatory. Training of the paramedical personnel, health workers and also the public regarding first aid and primary trauma care is also necessary.

Influence of dietary electrolyte balance and microbial phytase on growth performance, nutrient utilization, and excreta quality of broiler chickens.

The possible interaction between dietary electrolyte balance (DEB=Na+K-Cl, mEq/kg of diet) and microbial phytase on the performance and nutrient utilization of broiler starters and litter quality was examined in this study. A 4 x 2 factorial arrangement of treatments was used with 4 levels of DEB (150, 225, 300, and 375 mEq/kg of diet) and 2 levels of phytase (0 and 500 phytase units/kg of diet). Experimental diets were based on corn, soybean meal, and canola meal and were formulated to contain a nonphytate P level of 3 g/kg. The DEB levels were altered by the use of sodium bicarbonate and ammonium chloride. Each diet was offered to 6 replicates of 8 birds each from d 1 to 21. Increasing the DEB values from 150 to 300 mEq/kg had no effect (P>0.05) on the weight gains and feed per gain, but the gains were lowered (P<0.05) and the feed per gain was increased (P<0.05) at 375 mEq/kg. Feed intake was unaffected (P>0.05) by DEB levels. Supplemental phytase improved (P<0.05) the weight gains and feed intake at all DEB levels. Feed per gain was lowered (P<0.05) by phytase addition, but a tendency for a DEB x phytate interaction (P=0.06) was also observed, indicating that the responses to phytase may be affected by DEB level. The responses in feed per gain were greater at the lowest DEB level, and phytase addition had no effect on feed per gain at the highest DEB level. Dietary electrolyte balance levels had no effect on the AME(n) and ileal N digestibility to 300 mEq/kg, but lowered (P<0.05) both criteria at 375 mEq/kg. Phytase addition improved (P<0.05) the AME(n) and ileal N digestibility. The improvements in AME(n) with 500 U/kg of phytase addition in 150, 225, and 275 mEq/kg DEB were 53, 60, and 38 kcal/kg of DM, respectively. The main effect of DEB was significant (P<0.05) only for the ileal availability of Na and Cl, whereas added phytase influenced (P<0.05) the ileal availability of Ca, P, Na, K, and Cl. The effects of DEB were significant (P<0.05) for apparent ileal digestibility of all amino acids, except Ala (P=0.09), Arg, Met, and cystine. In general, the digestibilities of amino acids were unaffected when the DEB level was increased from 150 to 225 mEq/kg of diet, but decreased at the 300 and 375 mEq/kg levels. Phytase addition improved (P<0.06 to 0.05) ileal digestibility of all amino acids, except Met and Tyr. Increasing DEB had adverse effects on excreta scores and DM content. Phytase addition, however, had no effect on excreta quality. The overall results of the present study suggest that variability in phytase responses in nutrient utilization may be explained, in part, by differences in dietary electrolyte levels.

A systematic review and meta-analysis of efficacy and toxicity of disease modifying anti-rheumatic drugs and biological agents for psoriatic arthritis.

OBJECTIVE: Treatments for psoriatic arthritis (PsA) range from high-cost agents such as tumour necrosis factor (TNF) inhibitors evaluated in large randomised control trials (RCTs) and low-cost disease-modifying anti-rheumatic drugs (DMARDs) studied in less detail. We compared their efficacy and toxicity in a systematic review. METHODS: We searched Medline, PubMed and EmBase (1966-2006) for RCTs in PsA. We included RCTs that were randomised, placebo-controlled, in English, involved current treatments and only enrolled PsA patients. Efficacy was assessed by the numbers of patients withdrawn for lack of effect; toxicity by withdrawals for adverse events. RCTs were compared using risk ratios (RR) with 95% confidence intervals (CI). RESULTS: We identified 32 potentially relevant RCTs; 14 were excluded because they involved unused agents, were unblinded, were not placebo-controlled and enrolled patients with other diseases. 18 studies were included in the meta-analysis assessing DMARD monotherapy (11), DMARD combinations (one), TNF inhibitors (five) and alefacept (one). Treatment was more effective than placebo (RR = 0.35; 95% CI 0.25, 0.49) but caused more toxicity (RR = 2.33; 95% CI 1.61, 3.37). There was evidence that gold, sulfasalazine, leflunomide and TNF inhibitors were effective; gold and TNF inhibitors showed the largest effect sizes; TNF inhibitors had the best efficacy/toxicity ratio (number needed to harm/number needed to treat = 0.25); tolerability was least with gold and leflunomide. CONCLUSIONS: Efficacy/toxicity ratios were highest with TNF inhibitors followed by leflunomide, gold and sulfasalazine. Gold, though effective, has excessive toxicity and sulfasalazine, though of low toxicity, was also relatively ineffective.

Acute congestive heart failure secondary to an unusual underlying cause.

We report a patient who presented with non-specific features and rapidly developed multisystem disease as a result of Chrug-Strauss syndrome, a rare diffuse primary vasculitis. This case report highlights the importance of considering primary vasculitides as a differential diagnosis in patients presenting with multiple organ involvement as early specific therapy in such cases has shown to change the outcome.

Endogenous amino acid flow in the avian ileum: quantification using three techniques.

The aim of the present study was to compare the protein-free diet, guanidinated casein (GuC) and enzyme hydrolysed casein (EHC) methods for the quantification of endogenous amino acid (AA) flow in the avian ileum. Growing broiler chickens (5 weeks old) were used. All three assay diets were based on dextrose, and in the GuC and EHC diets GuC or EHC were the sole source of N. Endogenous AA flows determined with the use of protein-free diet were considerably lower (P<0.05) than those determined by the GuC and EHC methods. The total endogenous AA flows determined by the GuC and EHC methods were almost 3-fold greater (P<0.05) than those determined by the protein-free diet. The endogenous AA values obtained from GuC and EHC methods were similar (P>0.05), except for the flow of arginine, which was lower (P<0.05) in the EHC method. Glutamic acid, aspartic acid, threonine and glycine were the predominant endogenous AA present in digesta from the distal ileum. The contents of methionine, histidine and cystine were lower compared with other AA. The method of determination had no effect on the AA composition of endogenous protein, except for threonine, glutamic acid, lysine, arginine and cystine. The concentrations of threonine and arginine were lower (P<0.05) and that of lysine was higher (P<0.05) with the EHC method compared with the other two methods. The concentration of glutamic acid was greater (P<0.05) and that of cystine was lower (P<0.05) in the EHC and GuC methods compared with the protein-free diet method. The results showed that the ileal endogenous flows of N and AA are markedly enhanced by the presence of protein and peptides, above those determined following feeding of a protein-free diet. It is concluded that the use of EHC and GuC methods enables the measurement of ileal endogenous losses in chickens under normal physiological conditions.