A Comparative Study of the Retentive Strengths of Commercial and Indigenously Developed Luting Cements using Both Lathe-cut and Clinically Simulated Specimens.

INTRODUCTION: Superior adhesive strength in luting agents is of paramount significance in fixed partial denture success. In this in vitro study five cements were tested for retentive qualities, using both lathe-cut and hand-prepared specimens. MATERIALS AND METHODS: A total of 104 freshly extracted tooth specimens were prepared. Seventy of them were lathe-cut and 30 specimens were hand-prepared to simulate clinical conditions. Five different cements were tested, which included a compomer, a composite, a zinc phosphate, and 2 glass-ionomer luting cements. Of the 5, 2 trial cements were indigenously developed by Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India - a glass-ionomer cement (Chitra GIC) and a chemical-cure composite (Chitra CCC). All cements were compared within each group and between groups (lathe-prepared and hand-prepared). RESULTS: GC Fuji 1 (GC America) exhibited superior retentive strengths in both lathe-cut and hand-prepared specimens, whereas the compomer cement displayed the lowest values when tested. In lathe-cut specimens, statistical analysis showed no significant difference between GC Fuji 1 and indigenously developed Chitra CCC. CONCLUSION: Both Chitra CCC and GC Fuji 1 have comparable strengths in lathe-cut samples, making Chitra CCC a potential luting agent. Statistical analysis reveals that all cements, except GC Fuji 1, exhibited a significant decrease in strength due to the change in design uniformity. The chemical bonding of GC Fuji 1 proves to be quite strong irrespective of shape and precision of the tooth crown. CLINICAL SIGNIFICANCE: The indigenously developed Chitra GIC and Chitra CCC showed promising results to be used as a potential luting agent.

An unusual presentation of filariasis in a nonendemic country.

INTRODUCTION: Filariasis is an endemic disease with worldwide distribution in tropical and subtropical regions. It is uncommon in Qatar. The conventional diagnostic procedure is the demonstration of microfilaria in blood smears. Even with its high incidence, it is unusual to detect microfilaria in fine needle aspiration cytology (FNAC) smears. Although the 'filarial dance sign' is rarely documented, it remains a classical ultrasonographic sign in lymphatic filariasis. CASE PRESENTATION: We present a case of a 38-year-old male patient with fever, chills, shortness of breath and a tender warm swelling on his right thigh. Ultrasound of the thigh lesion showed the classical filarial dance sign. Subsequently FNAC from the lesion documented microfilaria in spite of absent peripheral blood eosinophilia and microfilaria. The patient underwent an incision and drainage of the thigh lesion and was treated with ivermectin and diethylcarbamazine. He was subsequently admitted to the medical ward and discharged home after two weeks in a stable condition. CONCLUSION: This case report illustrates the importance of diagnostic tools like ultrasound and FNAC along with a high index of clinical suspicion while evaluating patients presenting with unusual signs and symptoms. We would like to highlight the rarity of filarial presentation in a nonendemic country like Qatar. This case is unique since microfilaria was demonstrated in the pus aspirated from the thigh abscess and showed the filarial dance sign by ultrasound along with involvement of the pleura and pericardium.

A rare case of mullerianosis of the liver and lung mimicking metastatic biliary cystadenocarcinoma.

Anatomically, normal cells found in an abnormal site are known as choristoma. When any two of the three-cell lineage of the mullerian duct, that is endosalpinx, endocervix and endometrium, are found at an abnormal location, it is termed mullerian choristoma or mullerianosis. Mullerianosis histologically reveals glands of varying sizes lined by cervical, tubal and endometrial cells. Individual cell lineages like endometriosis of the ovary, endosalpingiosis and endocervicosis of the urinary bladder are common. But mullerianosis is quite rare, and as per literature, only about 20 cases have been reported. We report a mullerianosis involving the liver and lung in a 41-year-old female that mimicked metastatic biliary cystadenocarcinoma. It is the first case reported in literature where there is simultaneous involvement of the liver and lung by mullerianosis. The diagnosis was made with the help of histopathology and immunohistochemistry in the resected specimens.

A Validation Study of Non-invasive Scoring Systems for Assessing Severity of Hepatic Fibrosis in a Cohort of South Indian Patients With Non-alcoholic Fatty Liver Disease.

Introduction: Liver biopsy is the gold standard for diagnosing and staging non-alcoholic fatty liver disease (NAFLD), but liver biopsy has its limitations. Non-invasive tests (NITs) eliminate many of the drawbacks of liver biopsy. We did a retrospective observational study to validate the NAFLD Fibrosis Score (NFS score) and Fibrosis Score 4 (FIB-4 index) against the gold standard liver biopsy in a cohort of South Indian patients with NAFLD. Aims: The aim of this study was to validate the diagnostic accuracy of non-invasive fibrosis scoring systems (FIB-4 index and NFS), compared to that of liver histology, to predict AF in a cohort of south Indian patients with NAFLD. Material and methods: A retrospective observational analytical study of patients who had a liver biopsy with a diagnosis of NAFLD and had all the data for aetiology assessment and NIT calculation within 4 weeks of biopsy were included in the study. On liver biopsy, NAFLD was scored as per NIH's NASH committee grading system. NFS and FIB-4 index were calculated, and scores more than 0.676 and 2.67, respectively, were taken as the cut-off to predict advanced fibrosis (AF). The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve for NFS score and FIB-4 score to diagnose AF were calculated. Results: A total of 147 patients were included in the study. Of these, 56 (38.1%) patients had AF (Stage 3, 4). Patients with AF were more likely to be older and have diabetes mellitus (DM). Patients with AF had lower platelet count, higher aspartate aminotransferase (AST), lower albumin, and higher AST/alanine aminotransferase ratio. An NFS of >0.676 had a sensitivity of 68% and specificity of 100%, and an FIB-4 index of >2.67 had a sensitivity of 67% and specificity of 95.6 % in diagnosing AF in our study. Conclusion: The non-invasive scoring systems NFS and FIB-4 index can be used as a bedside tool for diagnosing liver fibrosis in NAFLD allowing liver biopsy to be used in a more targeted manner for patients diagnosed with AF on NITs.

Treatment of chronic hepatitis E in a patient with HIV infection.

BACKGROUND: Hepatitis E virus (HEV) infections in immunosuppressed patients can result in chronic hepatitis that rapidly progresses to cirrhosis (1, 2). When immunosuppressed transplant recipients are treated with pegylated -interferon and ribavirin, HEV clears and liver histology improves (2). However, we are not aware of reports about how this therapy works in patients with HIV infection. OBJECTIVE: To describe the clinical and laboratory response to antiviral therapy for chronic HEV infection in a patient also infected with HIV. CASE REPORT: We studied a 48-year-old bisexual male with HIV- 1 infection who was chronically infected with HEV genotype 3a and had several years of painful sensory neuropathy of uncertain cause in the lower limbs (3). He had malaise, persistently abnormal liver function tests, and active inflammation and cirrhosis on liver biopsy (Figure).Before beginning anti-HEV therapy, the patient had an undetectable HIV viral load and a CD4 cell count between 30 and 150 cells/mL for the previous 2 years while receiving combination antiretroviral therapy (abacavir­lamivudine once daily and lopinavir­ritonavir twice daily).

Immunosuppressive Drugs in Liver Transplant: An Insight.

Liver transplantation (LT) is the standard of care for end-stage liver failure and hepatocellular carcinoma. Over the years, immunosuppression regimens have improved, resulting in enhanced graft and patient survival. At present, the side effects of immunosuppressive agents are a significant threat to post-LT quality of life and long-term outcome. The role of personalized immunosuppression is to reach a delicate balance between optimal immunosuppression and minimal side effects. Today, immunosuppression in LT is more of an art than a science. There are no validated markers for overimmunosuppression and underimmunosuppression, only a few drugs have therapeutic drug monitoring and immunosuppression regimens vary from center to center. The immunosuppressive agents are broadly classified into biological agents and pharmacological agents. Most regimens use multiple agents with different modes of action to reduce the dosage and minimize the toxicities. The calcineurin inhibitor (CNI)-related toxicities are reduced by antibody induction or using mTOR inhibitor/antimetabolites as CNI sparing or CNI minimization strategies. Post-liver transplant immunosuppression has an intensive phase in the first three months when alloreactivity is high, followed by a maintenance phase when immunosuppression minimization protocols are implemented. Over time some patients achieve "tolerance," defined as the successful stopping of immunosuppression with good graft function and no indication of rejection. Cell-based therapy using immune cells with tolerogenic potential is the future and may permit complete withdrawal of immunosuppressive agents.

Comparison of demographic, clinical and laboratory characteristics between first and second COVID-19 waves in a secondary care hospital in Qatar: a retrospective study.

OBJECTIVE: To compare the patient profile and outcomes in Qatar during the first and second waves of the COVID-19 pandemic. SETTING: A retrospective observational study was conducted comparing the demographic, clinical and laboratory characteristics of patients with COVID-19 infection admitted to a secondary care hospital, during the first and second waves of the pandemic. PARTICIPANTS: 1039 patients from the first wave and 991 from the second wave who had pneumonia on chest X-ray and had a confirmed SARS-CoV-2 infection by a real-time PCR test of a nasopharyngeal swab were included. Patients with a normal chest X-ray and those who had a negative PCR test despite a positive COVID-19 antigen test were excluded. OUTCOME: Length of stay, need for mechanical ventilation, final disposition and mortality were the key outcomes studied RESULTS: Influenza like symptoms (18.5% in the first wave vs 36.1% in the second wave, p 0.001), cough (79.2% vs 87%, p<0.001) and dyspnoea (27.5% vs 38% p<0.001) were more common in the second wave. Second wave patients had significantly higher respiratory rate, lower peripheral oxygen saturation, needed more supplemental oxygen and had higher incidence of pulmonary embolism. More patients received hydroxychloroquine and antibiotics during the first wave and more received steroids, antivirals and interleukin-1 antagonist during the second wave. The second wave had a shorter length of stay (14.58±7.75 vs 12.61±6.16, p<0.001) and more patients were discharged home (22% vs 10%, p<0.001). CONCLUSIONS: Patients who presented during the second wave of COVID-19 pandemic appeared to be more ill clinically and based on their laboratory parameters. They required shorter hospitalisation and were more likely to be discharged home. This could represent greater expertise in handling such patients that was acquired during the first wave as well as use of more appropriate and combination therapies during the second wave.

Chronic granulomatous inflammation of the vulva: an unusual presentation with diagnostic and therapeutic difficulties.

Inflammation of the vulva can present as a manifestation of a localized problem or as part of a systemic disorder. Granulomatous vulvitis is a rare inflammatory condition that has histologic similarities to Crohn disease. Clinically, it presents with painless, chronic relapsing erythema, and edema, typically affecting the genital area. We report a case of extensive granulomatous vulvitis in a patient with no gastrointestinal evidence of Crohn disease. We describe difficulties with diagnosis and limitations in the treatment of isolated vulval granulomatous disease and aim to promote earlier recognition of the disease.

Complicated Brucellosis With Multisystem Involvement: Two Case Reports.

Brucellosis is a zoonotic infection caused by facultative intracellular bacteria of the genus Brucella. The ability of the organism to invade both phagocytic and non-phagocytic cells and survive in the intracellular environment makes brucellosis a systemic infection that can affect various organs of the body. Complications of brucellosis occur when the infection involves one or more focal body sites. Early identification of complications of brucellosis and initiation of appropriate treatment is the key to a better outcome. Here we present two cases of complicated brucellosis, both having multiple body site involvement.

COVID-19 Presenting as Acute Abdominal Pain: A Case Report.

As the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues across the globe, more details about the disease manifestations and clinical course have been emerging. The main clinical presentation of the ongoing coronavirus disease-19 (COVID-19) pandemic is respiratory symptoms. Along with this, the involvement of the gastrointestinal system and associated symptoms have also been reported. Here we present a case of a 58-year-old patient who presented with acute abdominal pain and was diagnosed with acute pancreatitis. He did not have any respiratory symptoms, but had radiological evidence of lung involvement and was diagnosed to be positive for COVID-19.

Wernicke's Encephalopathy Associated With Transient Gestational Hyperthyroidism and Hyperemesis Gravidarum.

Wernicke's encephalopathy (WE) is a potentially reversible yet severe neurological manifestation caused by thiamine (vitamin B1) deficiency. It is commonly associated with heavy alcohol consumption. Other rare causes include severe and prolonged vomiting, starvation, and prolonged intravenous feeding. WE patients usually present with the triad of ocular signs, ataxia, and confusion. In non-alcoholic patients, the full classic triad develops in 10-16% of cases. Characteristic MRI findings and clinical response to thiamine confirm the diagnosis. In this report, we present a case of WE in the setting of transient gestational hyperthyroidism and hyperemesis gravidarum (HG).

A Clinical and Radiographic Evaluation of Resonance Frequency Analysis of Sand Blasted Acid Etched (SAE) and Chemical Modified Sae Dental Implants.

AIMS AND OBJECTIVE: Chemically modified and sandblasted acid-etched (SAE) mechanism leads to wettability of surfaces of dental implants which helps in osseointegration. The present study was conducted to determine the implant stability quotient (ISQ) of SAE and SAE chemically modified dental implants. MATERIALS AND METHODS: The present study was conducted on 210 patients with 120 males and 90 females. Dental implants (Adin) with SAE (Group A) and SAE chemically modified (Group B) were inserted in patients. RFA was done immediately after implant insertion and after 1 week, 2 weeks, 6 weeks, 10 weeks, and 14 weeks. Results were statistically evaluated using SPSS Statistics for Windows, Version 21.0, IBM Corp., Armonk, NY, USA. RESULTS: Maximum patients were in the age group of 25-35 years (males - 65, females - 48), followed by 35-45 years (males - 40, females - 32) and 45-55 years (males - 15, females - 10). Maximum dental implants were given in the right side (88) in males than females (56). On the left side, maximum implants were given in females (62) than males (56). Maximum RFA value of 86.2 and minimum value of 44.6 were observed in SAE dental implants (A). The maximum mean RFA value in chemically modified implants SAE (B) was 89.4 and minimum was 32.5. CONCLUSION: It was observed that surface treatment of dental implants shows higher implant-bone osseointegration. There is fastest osseointegration in implants with hydrophilic surfaces than those with SAE surfaces. ISQ was higher than 75 in both groups, which indicate higher implant stability.

Glutathione and associated enzymes in toxic cataractogenesis-selenite model.

Glutathione, gamma-glutamyl cysteine synthetase (gamma -GCS) and glutathione reductase (GSH-R) activity were determined biochemically in the lens during various stages after subcutaneous administration of sodium selenite in multiple low dosages and single high dosages. The GSH concentration and gamma-GCS and GSH-R activity declined progressively after the selenite administration. The changes observed were discussed in relation to the possible role of selenite interaction with GSH and the enzymes.

Selenite cataract and its attenuation by vitamin E in Wistar rats.

PURPOSE: To study the role of vitamin E in preventing cataract formation in experimental animals. METHODS: An experimental model (selenite cataract) was selected for this study. Selenite cataract was produced in rats by subcutaneous administration of sodium selenite. Biochemical and histological changes following induction of selenite cataract in weanling Wistar rats were studied vis-a-vis the role of vitamin E in attenuating or preventing cataractogenesis. RESULTS: Vitamin E was capable of preventing selenite cataractogenesis. Selenite cataract did not develop in 91.6% (11 of 12) and 76.7% (8 of 12) vitamin E treated rats, when administered on the 12th and 10th post partum day respectively. CONCLUSION: The study confirmed that selenite induced cataract in Wistar rats is attenuated by vitamin E.

The natural history of autoimmune hepatitis presenting with jaundice.

BACKGROUND: Forty percent of patients with autoimmune hepatitis (AIH) present with acute jaundice/hepatitis. Such patients, when treated promptly, are thought to have a good prognosis. OBJECTIVES: The objective of this study was to describe the natural history of AIH in patients presenting with jaundice/hepatitis and to determine whether the diagnosis could have been made earlier, before presentation. METHODS: This study is a retrospective review of 2249 consecutive patients who presented with jaundice to the Jaundice Hotline clinic, Truro, Cornwall, UK, over 15 years (1998-2013) and includes a review of the laboratory data over a 23-year period (1990-2013). RESULTS: Of the 955 patients with hepatocellular jaundice, 47 (5%) had criterion-referenced AIH: 35 female and 12 male, the median age was 65 years (range 15-91 years); the bilirubin concentration was 139 µmol/l (range 23-634 µmol/l) and the alanine transaminase level was 687 IU/l (range 22-2519 IU/l). Among the patients, 23/46 (50%) were cirrhotic on biopsy; 11/47 (23%) died: median time from diagnosis to death, 5 months (range 1-59); median age, 72 years (range 59-91 years). All 8/11 patients who died of liver-related causes were cirrhotic. Weight loss (P=0.04) and presence of cirrhosis (P=0.004) and varices (P=0.015) were more common among those who died. Among patients who died from liver-related causes, 6/8 (75%) died less than 6 months from diagnosis. Cirrhosis at presentation and oesophageal varices were associated with early liver-related deaths (P=0.011, 0.002 respectively). Liver function test results were available in 33/47 (70%) patients before presentation. Among these patients, 16 (49%) had abnormal alanine transaminase levels previously, and eight (50%) were cirrhotic at presentation. CONCLUSION: AIH presenting as jaundice/hepatitis was mainly observed in older women: 50% of the patients were cirrhotic, and liver-related mortality was high. Some of these deaths were potentially preventable by earlier diagnosis, as the patients had abnormal liver function test results previously, which had not been investigated.

Endometrial metastasis of colorectal cancer with coincident endometrial adenocarcinoma.

Metastasis to the uterine corpus is uncommon and secondary colorectal tumours of the endometrium are rare. We describe a uterine tumour with components of both primary endometrial and metastatic colorectal carcinomata. In this case, a 72-year-old obese woman presented with a 2-week history of postmenopausal bleeding per vaginum and weight loss. She had an abdominoperineal resection 3 years previously for a Dukes stage B rectal carcinoma. A transvaginal ultrasonography showed a thickened endometrium. Histology immunophenotyping showed a CK7+, CK20+, CA125- and CEA+ colorectal metastasis (a profile consistent with her previous cancer) associated with a primary CK7+, CK20-, CA125+ and CEA- endometroid endometrial adenocarcinoma. We conclude this represents endometrial metastasis of colorectal carcinoma with coincident primary endometrial adenocarcinoma. We speculate as to whether the endometrial carcinoma arose de novo or was induced by the colorectal metastasis, or whether the primary endometrial tumour provided a fertile site for the colorectal metastasis.