Synovial fluid concentrations of matrix Metalloproteinase-3 and Interluekin-6 following anterior cruciate ligament injury associate with gait biomechanics 6 months following reconstruction.

OBJECTIVE: To compare gait biomechanics 6 months following anterior cruciate ligament (ACL) reconstruction (ACLR) between patients with the highest and lowest concentrations of synovial fluid (SF) interleukin-6 (IL-6) and matrix metalloproteinase-3 (MMP-3), as well as compared to uninjured controls. DESIGN: SF concentrations of IL-6 and MMP-3 were collected 7 ± 4 days post injury in 38 ACL injured patients (55% female, 21±4yrs, 25.3 ± 5.2BMI). ACL injured individuals were stratified into the lowest and highest quartiles based on IL-6 (IL-6Lowest and IL-6Highest) and MMP-3 (MMP-3Lowest and MMP-3Highest) concentrations. Gait biomechanics were collected on the injured limb 6 months post-ACLR and in 38 uninjured controls (50% female, 21±3yrs, 23.8 ± 2.8BMI). Functional analyses of variance were used to compare vertical ground reaction force (vGRF), knee flexion angle (KFA), and internal knee extension moment (KEM) waveforms throughout stance phase of gait to determine the proportions of stance differing between limbs and groups. RESULTS: Compared to uninjured controls, IL-6High and MMP-3High ACL subgroups demonstrated lesser vGRF (largest differences: IL-6, 7.88%BW; MMP-3, 11.05%BW) during early-stance and greater vGRF (largest differences: IL-6, 6.21%BW; MMP-3, 5.85%BW) in mid-stance, lesser KFA (largest differences: IL-6, 3.11°; MMP-3, 3.72°) and lesser KEM (largest differences: IL-6, 0.96%BW•m; MMP-3, 1.07%BW•m) in early-stance, as well as greater KFA in mid-stance (largest differences: IL-6, 1.5°; MMP-3, 2.95°). CONCLUSIONS: High SF concentrations of a proinflammatory cytokine and a degradative enzyme early post-ACL injury are associated with aberrant gait biomechanics in the injured limb at 6 months post-ACLR (i.e., lesser vGRF, KFA and KEM) linked to posttraumatic osteoarthritis development.

Pyoderma gangrenosum: an Indian perspective.

BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon, idiopathic, neutrophilic skin disease sometimes associated with systemic diseases. To our knowledge, there have been no case series of PG reported from India. AIM: To study the clinical features, associated systemic diseases and treatment methods in our case series. METHODS: In total, 18 cases of PG diagnosed at our institution in Mangalore were evaluated in a prospective study. RESULTS: Ulcerative PG was the most common variant, seen in all except one case. Paediatric patients constituted less than a quarter (27.77%) of the patients. Systemic diseases were associated with the disease in over half of the patients (55.55%). The pathergy test was positive in seven patients (38.88%), and all but one had associated systemic disease. Corticosteroids were mainly used for management. CONCLUSIONS: PG is a rare disease in India, but paediatric PG cases were relatively common. Ulcerative PG was the commonest type, and over half of the patients had associated systemic diseases. There were a significant number of patients with associated systemic disease who had a positive pathergy test.

Foveal neovascularisation in diabetic retinopathy: case report and review of literature.

To report a rare case of unilateral foveal neovascularisation in an asymptomatic patient with 15-year history of insulin-dependent diabetes mellitus and bilateral proliferative diabetic retinopathy and diabetic macular edema. Fundus fluorescein angiography and optical coherence tomography scan confirmed the presence of foveal neovascularisation. There was complete regression of the foveal neovascularisation after pan retinal laser photocoagulation. We review the literature on foveal neovascularisation in diabetic retinopathy and propose a possible pathogenic mechanism for development of foveal neovascularisation in diabetic retinopathy and the reason for the response to pan retinal laser photocoagulation.

Akathisia Induced by Abrupt Withdrawal of Risperidone: A Case Report.

Akathisia is a common movement disorder that occurs as a consequence of antipsychotic therapy. However, its occurrence secondary to risperidone withdrawal has been reported rarely. Reporting of such rare adverse event gains profound importance because changing the antipsychotics is very common in long term management of affective disorders. Here, we report a 17-year-old female who on withdrawal of risperidone developed akathisia. Further, we also discuss already reported cases in literature in relation to the current case.

Utility of CBCT for the measurement of palatal bone thickness.

INTRODUCTION: The palate is an alternative anchoring site for orthodontic implants. Adequate bone at mini-implant placement site can influence the success or failure of anchorage. Hence, it is imperative to measure the thickness of the palatal bone. MATERIALS AND METHODS: CBCT scans of 30 subjects in the age range of 12 to 28 years were retrospectively analyzed with the objective of measuring the palatal bone thickness. Thirty sites were identified on each CBCT scan with incisive foramen as a landmark and measurements were obtained anteroposteriorly as well as mediolaterally, using Carestream 3D imaging software. The data collected was analyzed using one-way ANOVA. RESULTS: Statistical analysis revealed higher palatal bone thickness at the median and paramedian regions of anterior palate, 4mm and 8mm distal to incisive foramen. CONCLUSION: CBCT is an ideal modality for measuring palatal bone thickness and can be utilized for locating the ideal site for placement of orthodontic mini-implants.

Paratharmone related protein (peptide): A novel prognostic, diagnostic and therapeutic marker in Head & Neck cancer.

Parathyroid hormone-related protein (PTHrP) is a promising modality of assessment of different critical features of cancer. It is a protein member of parathyroid hormone family, secreted by certain physiologic cells and by malignant tumors in an increased amount. Recent studies have confirmed that PTHrP massively contributes to malignant behaviour of oral cancers-cell proliferation, migration and invasiveness. Strong correlation was found between PTHrP overexpression and local bone invasion and percentage of tumor cells in metastatic nodes. Normal range of PTHrP in serum is 0.7-2.6ρmol/litre. Its down-regulation blocks cell cycle of cancer cell lines and inhibits cell proliferation and colony formation. PTHrP can be used as a diagnostic aid, prognostic marker and excellent research arena for designing novel anti-neoplastic drugs.

Sella Turcica Bridging As A Predictor Of Class II Malocclusion-An Investigative Study.

BACKGROUND: Sella turcica, the bony depression located in sphenoid bone houses and protects the pituitary gland. Formation and development of the sella turcica and teeth share, in common, the involvement of neural crest cells. The anterior part of the sella turcica is believed to develop mainly from neural crest cells, and dental epithelial progenitor cells differentiate through sequential and reciprocal interaction with neural crest-derived mesenchyme. Thus, any structural deviations in the sella, like bridging or roofing, are believed to be related to specific deviations in the facial skeleton and dental anomalies. Until now, there have been no studies concerning the prevalence of sella turcica bridging in skeletal Class II subjects. OBJECTIVE: The aim of this study was to analyse the prevalence of sella turcica bridging in subjects with class I and class II skeletal types and to check whether sella can be considered as diagnostic marker for skeletal class II malocclusion. MATERIALS AND METHODS: Lateral cephalometric images of 205 subjects in the age range of 13 to 25 years were retrospectively analysed and classified for the type of skeletal malocclusion and the radiographs were evaluated for the prevalence of bridging of the sella in these subjects. RESULTS: The results show significance in the prevalence of sella turcica bridging (partial/complete) among subjects with skeletal class II malocclusion.

Prevalence of temporal bone pneumatization in relation to temporomandibular joint - A computed tomographic study.

BACKGROUND: Pneumatic spaces represent sites of minimal resistance, facilitating the spread of various pathological processes into the joint such as tumors, infection or fractures or vice versa. Considering the clinical importance of temporomandibular joint, prevalence of pneumatic spaces of the temporal bone in relation to TMJ in the roof of the TMJ fossa; articular eminence; zygomatic process and peritubal area was determined using Computed tomography. Laterality and gender wise prevalence of pneumatic spaces around the TMJ was also assessed. MATERIALS AND METHODS: A total of 100 high-resolution CT images of adult patients subjected to CT scan for the base of skull/temporal bone were utilized. Axial, reformatted coronal and sagittal images were analyzed on a DICOM viewer for the presence and distribution of pneumatic spaces of the temporal bone around TMJ in the roof of TMJ fossa, articular eminence, zygomatic process and peritubal area. RESULTS: The extent of pneumatization of the temporal bone varied considerably. The prevalence of pneumatization of the roof of the TMJ fossa was 52%, articular eminence (12%), the root of the zygomatic process (5%) and peritubal area was 56%. Higher frequency of bilateral pneumatization was seen. No statistically significant correlation was seen in gender wise distribution of pneumatization. CONCLUSION: The present study revealed higher prevalence of pneumatization of temporal bone around TMJ. The knowledge of these air spaces is helpful for the interpretation of imaging studies and to understand the spread of pathological processes into the joint.

Parenteral anticoagulation for prolonging survival in patients with cancer who have no other indication for anticoagulation.

BACKGROUND: Basic research and clinical studies have generated the hypothesis that anticoagulation may improve survival in patients with cancer through an antitumour effect in addition to the antithrombotic effect. OBJECTIVES: To evaluate the efficacy and safety of heparin (including unfractionated heparin (UFH) and low molecular weight heparin (LMWH)) and fondaparinux to improve survival of patients with cancer. SEARCH STRATEGY: A comprehensive search for studies of anticoagulation in cancer patients including (1) A January 2007 electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and ISI the Web of Science; (2) Hand search of the American Society of Clinical Oncology and of the American Society of Hematology; (3) Checking of references of included studies; and (4) Use of "related article" feature in PubMed. SELECTION CRITERIA: We included randomized controlled trials (RCTs) in cancer patients without clinical evidence of venous thromboembolism comparing UFH, LMWH or fondaparinux to no intervention or placebo and RCTs comparing two of the three agents of interest. DATA COLLECTION AND ANALYSIS: Using a standardized form we extracted in duplicate data on methodological quality, participants, interventions and outcomes of interest including all cause mortality, venous thrombosis, symptomatic pulmonary embolism, major bleeding and minor bleeding. MAIN RESULTS: Of 3986 identified citations five RCTs fulfilled the inclusion criteria. In all included RCTs the intervention consisted of heparin ( either UFH or LMWH). The overall methodological quality of the included studies was acceptable. Overall, heparin therapy was associated with a statistically and clinically significant survival benefit (hazard ratio (HR) = 0.77; 95% CI: 0.65 to 0.91). In subgroup analyses, patients with limited small cell lung cancer experienced a clear survival benefit (HR = 0.56; 95% CI: 0.38 to 0.83). The survival benefit was not statistically significant for either patients with extensive small cell lung cancer (HR = 0.80; 95% CI: 0.60 to 1.06) or patients with advanced cancer (HR = 0.84; 95%: 0.68 to 1.03). The increased risk of bleeding with heparin was not statistically significant (RR = 1.78; 95% CI: 0.73 to 4.38). AUTHORS' CONCLUSIONS: Heparin has a survival benefit in cancer patients in general, and in patients with limited small cell lung cancer in particular. Heparin might be particularly beneficial in cancer patients with limited cancer or a longer life expectancy. Future research should investigate the survival benefit of different types of anticoagulants (in different dosing, schedules and duration of therapy) in patients with different types and stages of cancers.

Oral anticoagulation for prolonging survival in patients with cancer.

BACKGROUND: A number of basic research and clinical studies have led to the hypothesis that oral anticoagulants may improve the survival of patients with cancer through an antitumour effect in addition to their antithrombotic effect. OBJECTIVES: To evaluate the effectiveness and safety of oral anticoagulation (including vitamin K antagonists and ximelagatran) as an intervention to improve survival of patients with cancer. SEARCH STRATEGY: A comprehensive search for studies of anticoagulation in cancer patients including (1) a January 2007 electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ISI the Web of Science; (2) hand search of the American Society of Clinical Oncology (starting with its first volume, 1982) and of the American Society of Hematology (starting with its 2003 issue); (3) checking of references of included studies; and (4) use of "related article" feature in PubMed. SELECTION CRITERIA: Randomized clinical trials (RCTs) comparing vitamin K antagonist or ximelagatran to no intervention or placebo in cancer patients without clinical evidence of venous thromboembolism. DATA COLLECTION AND ANALYSIS: Using a standardized data form we extracted data on methodological quality, participants, interventions and outcome of interest that included all cause mortality, symptomatic deep venous thrombosis, symptomatic pulmonary embolism, major bleeding and minor bleeding. MAIN RESULTS: Of 3986 identified citations five RCTs fulfilled the inclusion criteria. Warfarin was the oral anticoagulant in all of these RCTs and it was compared to either placebo or no intervention. The overall methodological quality of these RCTs was acceptable. The effect of warfarin on reduction in mortality was not statistically significant at six months (Relative risk (RR) = 0.96; 95% CI 0.80 to 1.16), at one year (RR = 0.95; 95% CI 0.86 to 1.05) at 2 years (RR = 0.97; 95% CI 0.87 to 1.08) or at five years (RR 0.91; 95% CI 0.83 to 1.01). In the subgroup of patients with small cell lung cancer (SCLC), warfarin reduced mortality at six months (RR = 0.69; 95% CI 0.50 to 0.96) but not at one year (RR = 0.88; 95% CI 0.77 to 1.01). This six month mortality benefit was statistically significant in the subgroup of extensive SCLC (RR = 0.65; 95% CI 0.45 to 0.93) but not in the subgroup of limited SCLC (RR = 0.68; 95% CI 0.36 to 1.28). One study assessed the effect of warfarin on venous thromboembolism and showed a RR reduction of 85% (p = 0.031). Warfarin increased both major bleeding (RR = 4.24; 95% CI 1.85 to 9.68) and minor bleeding (RR = 3.34; 95% CI 1.66 to 6.74). Warfarin increased the risk of major bleeding (RR 5.46; 95% CI 3.04 to 9.81) and minor bleeding (RR 4.01; 95% CI 1.30 to 12.42) also in patients with SCLC. There was no evidence for a significant reduction in mortality in any other cancer subtype. AUTHORS' CONCLUSIONS: Existing evidence does not suggest a mortality benefit from oral anticoagulation in patients with cancer. In patients with SCLC, the evidence suggests a survival benefit at six months from warfarin particularly when the disease is extensive. The decision for a patient with extensive SCLC to start warfarin for survival benefit should balance that benefit with the downsides of increased bleeding risk in light of patient values for these outcomes.

Oral anticoagulation may prolong survival of a subgroup of patients with cancer: a cochrane systematic review.

To evaluate the effectiveness and safety of oral anticoagulants in improving survival of cancer patients. We conducted in January 2007 a comprehensive search for relevant randomized clinical trials (RCTs). We extracted data on methodological quality, participants, interventions and outcomes using a standardized form. Five RCTs fulfilled the inclusion criteria and all compared warfarin to either placebo or no intervention. Their overall methodological quality was acceptable. The effect of warfarin on mortality was not statistically significant at 6 months (RR = 0.96; 95% CI 0.80-1.16), at 1 year (RR = 0.95; 95% CI 0.86-1.05), at 2 years (RR = 0.97; 95% CI 0.87-1.08) or at 5 years (RR 0.91; 95% CI 0.83-1.01). In the subgroup of patients with small cell lung cancer (SCLC), warfarin reduced mortality at 6 months (RR = 0.69; 95% CI 0.50-0.96) but not at 1 year (RR = 0.88; 95% CI 0.77-1.01). This 6 months mortality benefit was statistically significant in the subgroup of extensive SCLC (RR = 0.65; 95% CI 0.45-0.93) but not in the subgroup of limited SCLC (RR = 0.68; 95% CI 0.36-1.28). Warfarin increased both major bleeding (RR = 4.24; 95% CI 1.85-9.68) and minor bleeding (RR = 3.34; 95% CI 1.66-6.74). The evidence suggests a survival benefit from warfarin in patients with extensive SCLC, but not in other patient groups. This survival benefit should be weighed against the increased risk for hemorrhage.

Morphological variations of median maxillary labial frenum: A clinical study.

BACKGROUND: Median maxillary labial frenum (MMLF) appears as a fold of mucous membrane extending from the lining of the mucous membrane of the lips towards the crest of the alveolar ridge on the labial surface. MMLF can demonstrate certain variations in their shape, size and position, both among individuals and within the same individual at different ages. Many clinicians, not being aware of the normal variations of median maxillary labial frenum misinterpret them as pathological entities. OBJECTIVES: The objectives of the study were to determine the prevalence of morphologic variations of MMLF, to classify the morphological variations of MMLF on the basis of their location on the frenum and to compare the morphological variations of MMLF among different age groups and genders. MATERIALS AND METHODS: The study was conducted on 700 males and 700 females of age 5 to 74 yrs, chosen randomly. They were equally divided on the basis of age into 7 groups, each group having equal gender distribution. The morphological variations of MMLF were classified according to Sewerin's classification and the attachments on the freni were further sub-classified. RESULTS: The commonest type of frenum was found to be the simple type, whereas bifid frenum was not found at all. Statistically significant difference was found in proportion of types of frenum among the different age groups and also in proportion of types of frenum among the different sites of presence of frenal attachments. No statistically significant difference was found in proportion of types of frenum in male and female subjects. CONCLUSION: This study shows that MMLF presents with an array of morphological variations. These morphological variations may sometimes pose a complicating factor in maintaining oral hygiene, speech, mastication, esthetics, denture construction, etc. Hence, appropriate recognition of frenal variations and subsequent modification of treatment procedures are essential for a successful outcome of therapy.

Acute glaucoma presentations in the elderly.

Acute glaucoma classically presents with severe pain, redness, and reduced vision in the affected eye, and severe cases can also have systemic symptoms. We report three cases of acute glaucoma in elderly patients. The diagnosis of acute glaucoma in a patient who presents with sudden onset of a painful, red eye with reduced visual acuity, a hazy cornea, and a fixed, semi-dilated pupil is comparatively straightforward. However, any patient with headache, malaise, or gastrointestinal disturbance, especially with clinical signs of an acute red eye and reduced vision, should alert doctors to the possibility of acute glaucoma. This is especially important in elderly people, who may not volunteer any specific ocular symptoms.

Leprosy scenario in southern part of Dakshina Kannada district, Karnataka, after 16 years of control work.

This article examines the changes that occurred in epidemiological indices over a period of 16 years following the introduction of MDT in Ullal town, south of Mangalore city, having a population of 130,000. The analysis indicates that new case-detection rates and prevalence rates showed a declining trend due to shorter duration of treatment with MDT. There was a ten-fold reduction in the prevalence rate during the first 6 years, from 23 in 1987 (230 cases) to 2.76 per 10,000 (29 cases) at the end of 16 years. The number of nmultibacillary cases among the newly detected cases showed a downtrend (from 28 cases in 1987 to 5 in 2001). The number of newly detected cases presenting with single lesion also showed a declining trend.

Phacoemulsification in a patient with marked cervical kyphosis.

A patient with long-standing ankylosing spondylitis and chronic uveitis needed cataract extraction in his only eye. Extensive spinal deformities, including cervical kyphosis, prevented him from being positioned satisfactorily for surgery using a routine head-end or temporal position for the surgeon. The best possible position for surgery was achieved using an orthopedic operating table, which allowed the patient's head to be reclined to a position of 60 degrees to the horizontal. Successful combined phacoemulsification and trabeculectomy was then performed, although the angle of approach for the surgeon and the operating microscope was awkward.

Visual outcome with the array multifocal intraocular lens in patients with concurrent eye disease.

PURPOSE: To evaluate whether the distance visual outcome with the Array(R) multifocal intraocular lens (IOL) is comparable to that of a monofocal IOL in eyes with concurrent disease and to assess whether these eyes benefit from the IOL's multifocality. SETTING: Department of Ophthalmology, Arrowe Park Hospital, Wirral, United Kingdom. METHODS: This prospective study comprised 133 eyes of 111 patients with cataract and concurrent disease such as macular degeneration, glaucoma, and diabetic retinopathy. Eighty-one eyes (70 patients) received an Array multifocal IOL after phacoemulsification. A control group of 52 eyes (41 patients) received a monofocal IOL of similar design (AMO SI-40NB). Visual outcomes in terms of uncorrected and best corrected distance and near acuities were evaluated. RESULTS: In both the multifocal and the monofocal IOL groups, the number of eyes achieving a best corrected visual acuity of 6/12 and N8 or better (55 and 37 eyes, respectively) was comparable (P > or =.999; 95% confidence interval [CI] -0.152 to 0.172). There was a borderline statistically significant difference in the number of eyes achieving an uncorrected visual acuity of 6/12 or better and N8 or better in the multifocal IOL (11 eyes) and monofocal (2 eyes) groups (P =.047, 95% CI -0.001 to 0.196). A significantly higher number of eyes in the multifocal group (40 eyes) than in the monofocal IOL group (4 eyes) achieved a distance-corrected acuity of 6/12 and N8 or better (P =.0001; 95% CI 0.274 to 0.539). CONCLUSIONS: The Array multifocal IOL produced distance visual outcomes comparable to those of the AMO SI-40NB monofocal IOL in patients with concurrent eye disease. A significant proportion of these patients benefited from the IOL's multifocality. Management of associated eye disease was not compromised by the nature of the IOL.

Bilateral anterior ischaemic optic neuropathy due to optic disc drusen.

PURPOSE: To report a case of bilateral anterior ischaemic optic neuropathy due to buried optic disc drusen. METHODS: Case report. RESULTS: A 64-year-old man presented with swollen optic discs and features suggestive of anterior ischaemic optic neuropathy (AION) in the left and right eye on two separate occasions ten months apart. Detailed ocular examination at presentation and systemic investigations did not reveal an underlying cause for the AION. At a later follow-up, optic disc drusen were noted in both eyes as partial optic atrophy had set in. This was confirmed by ultrasound B scan and demonstration of autofluorescence. CONCLUSIONS: In patients presenting with AION uncommon underlying causes must be considered. Routine ultrasound B scan at presentation can easily establish or exclude optic disc drusen as an underlying cause.

Comparison of impact strength of acrylic resin reinforced with kevlar and polyethylene fibres.

The present study was done to evaluate the impact strengths of heat-activated acrylic resins reinforced with Kevlar fibres, polyethylene fibres and unreinforced heat activated acrylic resin. Each of three groups had 25 specimens. Brass rods of uniform length of 40 mm and diameter of 8 mm were used to prepare the moulds. A combination of long fibres (40 mm length) and short fibres (6 mm length) were used. The total amount of fibres incorporated was limited to 2% by weight of the resin matrix. Short and long fibres of equal weight were incorporated. The short fibres were mixed with polymer and monomer and packed into the mould, while, the long axis of the specimen, perpendicular to the applied force. The specimens were then processed. Impact strength testing was done on Hounsfield's impact testing machine. Kevlar fibre reinforced heat activated acrylic resin specimens recorded higher mean impact strength of 0.8464 Joules, while polyethylene fibres reinforced heat activated acrylic resin recorded mean impact strength of 0.7596 joules. The unreinforced heat activated acrylic resin recorded mean impact strength of 0.3440 Joules.