Concomitant falciparum malaria and Hyperreactive Malarial Splenomegaly in an adolescent boy from eastern India: A tale of rare coincidences.

Hyperreactive malarial splenomegaly (HMS) is one of the important causes of massive splenomegaly in malaria endemic zones. It is thought to represent a dysfunctional immune response to recurrent malarial infection. It is usually reported due to physical symptoms of splenomegaly and hypersplenism and fever is classically absent. Concomitant malaria with HMS is a very rare finding in the Indian context. Here, we report a case of symptomatic falciparum malaria presented with fever, jaundice, massive splenomegaly and pancytopenia. Persistent massive splenomegaly led us to investigate thoroughly and finally diagnosed it as HMS with concomitant falciparum malaria. He received standard antimalarial treatment and 12 months of weekly chloroquine and completely recovered without any relapse or complications.

A Defective Oxidative Burst and Impaired Antigen Presentation are Hallmarks of Human Visceral Leishmaniasis.

PURPOSE: Survival of the Leishmania parasite within monocytes hinges on its ability to effectively nullify their microbicidal effector mechanisms. Accordingly, this study aimed to delineate this biological niche in patients with visceral leishmaniasis (VL). METHODS: In monocytes, the redox status, antigen presenting capacity, expression of Toll-like receptors (TLRs), co-stimulatory molecules (CD80/86) and generation of intracellular cytokines (IL-8, IL-1ß, IL-10 and LAP-TGF-ß1) was measured by flow cytometry, levels of circulating cytokines (IL-1ß, IL-6, TNF-α, IL-8, IL-4, IL-13, IL-10 and GM-CSF) by ELISA and arginase activity by spectrophotometry. RESULTS: Within monocytes, generation of an oxidative burst was markedly attenuated as evident by decreased generation of nitric oxide and reactive oxygen species, concomitant with raised levels of thiols. This was accompanied by lowered frequency of TLR4(+) monocytes, but the arginase activity remained unaltered. Pathogen persistence was enhanced by the predominance of anti-inflammatory cytokines within monocytes, notably IL-10. Alongside, development of adaptive immunity was severely attenuated as manifested by a pronounced impairment of antigen presentation and co-stimulation evident by down regulation of CD54, HLA-DR and CD86. Treatment corrected the redox imbalance and reversed the impaired antigen presentation. CONCLUSIONS: In VL, monocyte functions were severely impaired facilitating parasite persistence; anti-leishmanial chemotherapy mediated parasite elimination through modulation of the macrophage microenvironment by restoring its redox status and antigen presenting capacity.

Comparative evaluation of osseodensification drilling versus conventional drilling technique on dental implant stability: A systematic review.

AIM: The present systematic review compares the stability, crestal bone levels and efficacy of osseodensification (OD) drilling techniques for dental implant placement to traditional drilling methods. SETTINGS AND DESIGN: The Cochrane online library, PubMed, Scopus, and other well-known online resources are used in the research. Using a systematic review design, the current study examines published qualitative studies with an emphasis on analysis. MATERIALS AND METHODS: Using precise keywords, a thorough search of pertinent databases was carried out in accordance with PRISMA standards. Studies testing dental implant stability, crestal bone levels and clinical results using both OD and traditional procedures were covered by the inclusion criteria. STATISTICAL ANALYSIS USED: The risk of bias and quality of included studies was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomized controlled trials. RESULTS: A total of 170 patients and 334 implants from Egypt, India, and Brazil were included in eight papers that made up the systematic review. In several clinical situations, osseodensification outperformed standard drilling in terms of implant durability, bone development, and torque data. Statistical analysis presented the lowest risks, while blinded outcome assessment, allocation concealment, random sequence generation, incomplete outcome data and experimental technique revealed higher risks. Bias assessment found various risks across different components. CONCLUSION: The thorough examination of eight papers demonstrates that osseodensification is a technique with great promise in the field of dental implants. It exhibits superior torque values, bone development, and stability when compared to traditional drilling. The overall results highlight the potential of osseodensification to improve clinical outcomes and advance the science of dental implantology, even in the face of variances in bias concerns.

Role of plasma process gas on permeate flux augmentation of cellulose nitrate membrane for mud water treatment.

A comparative study between Nitrogen (N2) and Argon (Ar) plasma is carried out to investigate its effect on surface morphology, hydrophilicity, permeate flux and ageing of cellulose nitrate polymeric membranes in the present work. Langmuir probe and Optical Emission Spectroscopy are used to characterize the plasma. The SEM analysis reveals the noticeable macro-void creations and pore enlargement for both N2 and Ar plasma. The AFM analysis shows a higher surface roughness for Ar plasma treatment as compared to N2 plasma treatment. XPS analysis confirms the changes in the polymer matrix along with the incorporation of various functional groups on the membrane surface as a result of the plasma treatment. A better hydrophilic nature with prolonged plasma treatment is observed for Ar plasma as compared to N2 plasma treatment. The present results show a higher permeate flux with a high rejection rate for Ar plasma treatment in comparison to N2 plasma, which might be due to the pore size and pore area enlargement of the membrane. The hydrophobic recovery for both the plasma-treated membranes is found significant for the initial ageing period of 7 days and found almost stable in nature after 7 days. A diffusion-based theoretical model is developed to study the hydrophobic recovery of plasma-treated membranes. A strong alignment between experimental and theoretical results is observed in the present work. The Cake Filtration model, derived from the Hermia model, is identified as the most suitable model for describing the fouling mechanisms for the present work.

Histoid leprosy complicated by erythema nodosum leprosum mimicking connective tissue disease.

Erythema nodosum leprosum (ENL) is an immunological complication of leprosy seen in 50% of lepromatous and 10% of borderline lepromatous leprosy. It usually presents as a multisystem disease with papulo-nodular skin lesions and fever. Arthralgia or arthritis is a common initial presentation of erythema nodosum leprosum. Pure rheumatologic presentation of lepromatous leprosy complicated by erythema nodosum leprosum is extremely rare, mimics connective tissue disease and is treated with steroids.

Rhinofacial Conidiobolomycosis - A rare fungal infection of tropics.

Fungal sinusitis may be caused by filamentous fungi such as mucorales, aspergillus and entomophthorales. Mucormycosis and aspergillosis have immunocompromised states as specific risk factors, whereas entomophthorales may occur in apparently healthy persons having significant soil contact. This is, nonetheless, a rare condition with involvement of mucosa of the nose, para nasal sinuses and centrofacial soft tissues, without bony or angioinvasion. It grows relentlessly, however, and may mimic soft tissue neoplasm causing facial disfigurement.

Efficacy of implantoplasty in management of peri-implantitis: A systematic review.

Aim: Peri-implantitis causes progressive loss of the supporting bony structure around the dental implant. Implantoplasty mechanically removes contaminated threads to achieve smoother implant surface thus reducing the bacterial load enabling fibroblastic growth to stimulate the healing effect. This Systematic review is done to appraise the outcome of implantoplasty on surface quality of Implant (roughness), biocompatibility of implants in peri-implantitis cases. Settings and Design: The Settings of the studies are major online databases like PubMed, Scopus, and Cochrane online library. The design of the current study is systematic review of published qualitative studies. Materials and Method: 37 articles were identified for the present review and systematic electronic literature search was done from August 2022 to January 2023, via PubMed, Scopus, Medline, and The Cochrane Library (Wiley) databases [PRISMA guidelines]. In vitro studies on implantoplasty for peri-implantitis were included for the review. 2 examiners independently selected based on the inclusion criteria and recorded the necessary data. Statistical Analysis Used: Risk of bias assessment tool was evaluated with Newcastle Ottawa scale (NOS) and screened based on Selection, Comparability, and Outcome with the following categories: - maximum of 4, 2 and 4 points respectively. The observations were tabulated and analysed. Results: Among the 8 selected studies, two studies reported no statistical difference between implantoplasty and control, one study proposed carbide burs were better than diamond burs, another study also suggested multilaminar burs were better than diamond and carbide. The Newcastle Ottawa scale (NOS) score for the quality of the included studies ranged from 6 to 8. Two of the studies had score of 6 points, eight had 7 points and one had 8 points. Conclusion: Implantoplasty has been recommended as an efficacious treatment protocol for peri-implantitis that helps to diminish the inflammation and accompanied by a high success rate.

Cladophialophora bantiana - A rare cause of soil-transmitted fungal brain abscess in tropical countries.

Cladophialophora and other dematiaceous or pigmented fungi are inhabitants of soil and decaying vegetation in tropical and sub-tropical environments. It usually causes subcutaneous phaeohyphomycosis post-inoculation by thorns or vegetable matter prick. It may be inhaled into paranasal sinuses and lungs with subsequent clearance by intact host immunity. In immunocompromised individuals, it can cause invasive sinusitis or pneumonitis followed by hematogenous dissemination to involve distant organs, particularly the brain. Disseminated disease with hematogenous brain abscess is found occasionally. We encountered such an interesting case and successfully treated it with surgical drainage followed by dual anti-fungal therapy.

Entomophthoramycosis: An unusual cause of facial disfigurement.

Entomophthoramycosis is a rare fungal infection of nose, paranasal sinuses and subcutaneous tissues found in tropical and subtropical region. From India very few cases have been reported. Here we report a case of Entomophthoramycosis due to Conidiobolus coronatus from the eastern India who presented with slowly growing rhinofacial swelling and right sided nasal obstruction due to intranasal mass. The case was diagnosed by typical histopathological findings of broad aseptate hyphae with surrounding eosinophilic granular material (Splendore Hoeppli phenomenon) on microscopy of nasal biopsy material and confirmed by PCR assay of DNA and sequencing from biopsy tissue. Treatment with saturated solution of potassium iodide and itraconazole was successful and clinical cure was attained in 8 months.

Pulmonary tuberculosis and pneumocystis jirovecii concurrent pneumonia in HIV infected patients at a resource limited setting in Eastern India: A case series.

Pneumocytis jirovecii pneumonia (PJP) and Pulmonary TB (PTB) both are common opportunistic infections among HIV infected individuals. But concurrent infections pose a diagnostic challenge owing to similar clinical features. Data suggests a high prevalence of such concurrent infections in developing countries but limited diagnostic modalities especially in resource constraint setup limits accurate diagnosis. At our centre we came across 6 newly diagnosed PTB patients among HIV infected ones had persistent shortness of breath (SOB) and hypoxia despite starting anti-tuberculous treatment (ATT). We excluded concomitant bacterial pneumonia by imaging, sputum examination and blood culture. Serum lactate dehydrogenase (LDH) was estimated and hypoxia by arterial blood gas (ABG). We found all 6 patients had elevated serum LDH, hypoxia and imaging suggestive of PJP were offered sputum for Geisma stain and standard treatment for PJP in form of Bactrim-double strength and steroid. 1 patient had PJ cysts in sputum. 5 patient's classical radiologic findings in form of ground glass opacities in lower lobes along with bilateral infiltrates and 1 had honeycombing. Serum LDH was elevated all 6 subjects. 5 were newly diagnosed HIV and 4 had CD4 count below 50 cells/mm3 and 2 had below 200 cells/mm3.1 patient had developed bilateral pneumothorax as complication. 4 patients responded to treatment and 2 (33.3%) died of respiratory failure during treatment. We were able to diagnose only severe PJP cases as concurrent infection with PTB as there was no availability of broncho alveolar lavage (BAL) as well as direct fluorescent antigen (DFA) test for PJ detection. A high index of suspicion for PJP even in PTB patients with low CD4 count will guide to appropriate therapy for both infections and eventually reduces morbidity and mortality.

Very low-noise ENG amplifier system using CMOS technology.

In this paper, we describe the design and testing of a system for recording electroneurographic signals (ENG) from a multielectrode nerve cuff (MEC). This device, which is an extension of the conventional nerve signal recording cuff, enables ENG to be classified by action potential velocity. In addition to electrical measurements, we provide preliminary in vitro data obtained from frogs that demonstrate the validity of the technique for the first time. Since typical ENG signals are extremely small, on the order of 1 1 microV, very low-noise, high-gain amplifiers are required. The ten-channel system we describe was realized in a 0.8 microm CMOS technology and detailed measured results are presented. The overall gain is 10 000 and the total input-referred root mean square (rms) noise in a bandwidth 1 Hz-5 kHZ is 291 nV. The active area is 12 mm(2) and the power consumption is 24 mW from +/-2.5 V power supplies.

A rare case of Weil's disease with alveolar haemorrhage.

Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season mimicking other febrile viral illness. In the rare case, the disease leads to renal and hepatic involvement with hemorrhage which may be associated with multisystem organ dysfunction in form of pulmonary, cardiac and central nervous system, when it is known as Weil's disease. Rarely haemorrhagic manifestations are assosciated. Early diagnosis is important as sometimes the disease may be life threatening. Proper antibiotics results in dramatic improvement. We hereby presented a case that had clinical features of Weil's disease with cough, dyspnoea and haemoptysis. Leptospirosis was detected on ELISA testing. Patient was cured rapidly with antibiotics.