Ectopic parathyroid adenoma presenting as facial expansile growths.

BACKGROUND: Giant cell reparative granuloma of the facial skeleton is a rare presentation of hyperparathyroidism. METHODOLOGY: A 17-year-old girl presented with progressive expansile bony growths of the mandible and maxilla. The case was investigated using biopsies, blood tests, imaging, and surgery. RESULTS: Biopsies confirmed giant cell reparative granuloma. Blood testing revealed very high parathyroid hormone levels, and brown tumours due to primary hyperparathyroidism weresuspected. Surgical removal of an ectopic adenoma led to correction of the endocrine condition. CONCLUSIONS: To our knowledge, this is the first reported case of multiple brown tumours of the facial skeleton due to an ectopic parathyroid adenoma. Diagnostic pitfalls and therapeutic challenges are described.

Molecular modeling and in-silico engineering of Cardamom mosaic virus coat protein for the presentation of immunogenic epitopes of Leptospira LipL32.

Expression of Cardamom mosaic virus (CdMV) coat protein (CP) in E. coli forms virus-like particles. In this study, the structure of CdMV CP was predicted and used as a platform to display epitopes of the most abundant surface-associated protein, LipL32 of Leptospira at C, N, and both the termini of CdMV CP. In silico, we have mapped sequential and conformational B-cell epitopes from the crystal structure of LipL32 of Leptospira interrogans serovar Copenhageni str. Fiocruz L1-130 using IEDB Elipro, ABCpred, BCPRED, and VaxiJen servers. Our results show that the epitopes displayed at the N-terminus of CdMV CP are promising vaccine candidates as compared to those displayed at the C-terminus or at both the termini. LipL32 epitopes, EP2, EP3, EP4, and EP6 are found to be promising B-cell epitopes for vaccine development. Based on the type of amino acids, length, surface accessibility, and docking energy with CdMV CP model, the order of antigenicity of the LipL32 epitopes was found to be EP4 > EP3 > EP2 > EP6.

Immunologic profiles of HIV-infected and uninfected commercial sex workers in the Vellore region of Southern India.

Female commercial sex workers (CSW) play a major role in the transmission of HIV infection in India. Their immunology has not been characterized. To determine HIV-related immunologic changes and establish baseline data for CSW, blood cell counts and serum immunoglobulin levels of 35 HIV-positive, asymptomatic CSW; 37 HIV-negative CSW, and 35 age-matched, non-CSW, healthy women controls were compared. The CSW, irrespective of their HIV status, had abnormalities that included high eosinophil, lymphocyte, and CD8 counts and low CD4:CD8 ratios. The only significant difference between the HIV-positive and HIV-negative CSW was in their neutrophil and CD8 counts (p < 0.05, ANOVA). Compared with normal controls, the CSW had significantly elevated serum IgG, IgA, and IgM levels; however, no significant difference was shown between CSW who tested positive for HIV and those who did not. These results suggest that the CSW of Vellore region in Southern India have hyperimmunoglobulinemia irrespective of their HIV status and thus highlight the need to use appropriate controls when immunologic evaluation studies are done.

PIP: As part of India's National AIDS Surveillance Program, blood cell counts and serum immunoglobulin (Ig) levels were compared in 35 asymptomatic HIV-infected commercial sex workers (CSWs), 37 HIV-negative CSWs, and 35 age-matched, healthy, non-CSW controls. Cases and controls were residents of southern India's Vellore region. All CSWs, regardless of HIV status, had had repeated unprotected sex with 3-10 clients per night for a period of 5 or more years and had been treated at least 3 times for sexually transmitted diseases (STDs) in the past 5 years. The frequencies of the most common STDs--genital ulcers, genital warts, syphilis, and gonorrhea--were similar in HIV-negative and HIV-positive CSWs. All CSWs had significantly higher levels of IgG, IgA, and IgM than non-CSW controls, but there were no significant differences in Ig levels between the two groups of CSWs. The only significant difference between HIV-positive and HIV-negative CSWs was in their neutrophil and CD8 counts. When compared to healthy controls, HIV-infected CSWs had significantly lower neutrophil counts and CD4:CD8 ratios and significantly higher eosinophil, lymphocyte, and CD8 cell counts. HIV-negative CSWs had significantly higher eosinophil and lymphocyte counts and lower CD4:CD8 ratios than healthy controls. The abnormal immunologic profile detected in HIV-negative as well as HIV-positive CSWs suggests that stimuli other than HIV infection are responsible for CSWs' hyperimmunoglobulinemia. These findings further highlight the importance of using appropriate controls in immunologic evaluation studies.