A preliminary evaluation of tick cement-cone protein extract for a vaccine against Hyalomma infestation

BACKGROUND

Vaccines have been widely exploited to prevent tick-borne infections in cattle. Most vaccines have faced failure in the field because of inconsistency in an immune response. It is presumed that the cement-cone proteins of ticks that participate in the acquisition of blood meal for ticks possess strong immune-stimulating properties and, hence, could be a useful candidate in vaccine development.

AIMS

We evaluated cement-cone proteins of tick Hyalomma anatolicum as a vaccine candidate against infestations of H. anatolicum and H. aegyptium in cattle.

METHODS

The cement-cone proteins were extracted from H. anatolicum to develop stage-reactive and immunogenic cross-reactive vaccine against the infestation of two species of ticks H. anatolicum and H. aegyptium. The immune response of the vaccine was tested against cement-cone proteins starved, partially fed, and richly fed ticks.

RESULTS

The findings of the present study demonstrated the cross-reactivity among the two species of ticks that belonged to the same genus (Hyalomma). The antigenic similarity between the two ticks species suggests that a common antigen may possibly be suitable for a vaccine against the two different species of ticks. The results have also indicated that the 23 kDa cement-cone protein of H. anatolicum and H. aegyptium may be responsible for the induction, or elicitation of immunogenic, common stage reactive, and cross-reactive host immune responses with consistent intensity throughout the life stages of ticks.

CONCLUSION

The vaccine based upon cement-cone proteins of ticks may be a useful deterrent against tick-borne infections in cattle in countries like Pakistan.

Convalescent plasma, cytomegalovirus infection, and persistent leukopenia in COVID-19 recovery phase: What is the link?

Therapies used to tide over acute crisis of COVID-19 infection may lower the immunity, which can lead to secondary infection or a reactivation of latent infection. We report a 75-years-old male patient who had suffered from severe COVID-19 infection three weeks earlier and who had been treated with corticosteroids and convalescent plasma along with other supportive therapies. At time of discharge he had developed leukopenia which worsened at 1-week follow up visit. On 18th day post-discharge, he became very sick and was brought to our hospital with complaints of severe persistent dysphagia. During evaluation he was diagnosed to have an acute cytomegalovirus infection and severe oropharyngeal thrush. Both COVID-19 and cytomegalovirus are known to cause synergistic decrease in T cells and NK cells leading to immunosuppression. The patient made complete recovery with a course of intravenous ganciclovir and fluconazole. Persistent leukopenia in high risk and severely ill cases should give rise to a suspicion of COVID-19 and cytomegalovirus co-infection.

In vitro comparison of resonance frequency analysis devices to evaluate implant stability of narrow diameter implants at varying drilling speeds in dense artificial bone blocks

BACKGROUND

There are no studies that have assessed the implant stability quotient (ISQ) values of narrow diameter implants placed in artificial dense bone blocks at varying drilling speeds (DSs).

PURPOSE

The aim of the present in vitro experiment was to compare the performance of OSSTELL and Penguin devices to evaluate implant stability at DSs of 800 and 2000 rpm.

MATERIALS AND METHODS

A total of 360 osteotomies were created in dense artificial bone blocks at DSs of 800 and 2000 rpm. Dental implants from three manufacturers (group-1: NobelActive implants, Nobel Biocare, Yorba Linda, California; group-2: Zimmer, Eztetic-Zimmer implants, Zimmer Biomet Dental, Palm Beach Gardens, Florida; and group-3: Astra Tech implant system, Dentsply Sirona, York, Pennsylvania) were randomly placed in these osteotomies using an insertion torque of 15 Ncm (60 implants/group). Implant stability in all bone blocks immediately following implant placement was evaluated using the OSSTELL and Penguin devices. ISQ values were presented as means ± SD. Statistical significance was set at P < .05.

RESULTS

There was no significant difference in the ISQ values obtained from the OSSTELL and Penguin devices for implants in groups 1, 2, and 3. There was no significant difference when ISQ values obtained from the OSSTELL device were compared with the Penguin device for narrow diameter dental implants placed in dense bone blocks with osteotomies performed at 800 and 2000 rpm. ISQ values showed statistically significant higher values for OSSTELL compared to Penguin device.

CONCLUSION

The OSSTELL and Penguin devices are reliable for the assessment of implant stability in dense artificial bone. Implant design and site-DS does not seem to have a significant impact of implant stability in artificial dense bone blocks.

In Vitro Effect of Drilling Speed on the Primary Stability of Narrow Diameter Implants with Varying Thread Designs Placed in Different Qualities of Simulated Bone

It is hypothesized that there is no statistically significant impact of drilling speed (DS) on the primary stability (PS) of narrow-diameter implants (NDIs) with varying thread designs placed in dense and soft simulated bone. The aim of this in vitro study was to evaluate the impact of DS on the PS of NDIs with varying thread designs placed in dense and soft simulated bone. Two hundred and forty osteotomies for placement of various implant macro-designs were divided into three groups (80 implants per group): Group A (NobelActive, 3.0/11.5 mm); Group B (Astra OsseoSpeed-EV, 3.0/11 mm); and Group C (Eztetic-Zimmer, 3.1/11.5 mm) implants. These implants were placed in artificial dense and soft simulated bone using DSs of 800 and 2000 revolutions per minute (RPM). Resonance frequency analysis (RFA) and implant stability quotient (ISQ) were assessed. Group comparisons were performed using the one-way analysis of variance with Tukey’s post hoc tests. Level of significance was set at P < 0.05. In groups A and B, there was no difference in the ISQ for NDIs inserted in dense bone at 800 and 2000 RPM. In Group C, ISQ was significantly higher for NDIs placed in dense bone at 800 PRM compared to 2000 RPM (P < 0.05). In Group A, ISQ values were significantly higher for NDIs inserted in soft bone at 2000 RPM as compared to those inserted at 800 RPM (P < 0.05). For NDIs, a lower drilling speed in dense artificial simulated bone and a higher drilling speed in soft artificial simulated bone is associated with high primary stability.

Leprosy: A Great Mimicking Disease

Leprosy may mask a variety of diseases. One such disease is systemic lupus erythematosus. The early differentiation between the two diseases is of utmost importance to institute appropriate treatment and reduce patient morbidity and mortality. Leprosy is a communicable, chronic granulomatous disease caused by Mycobacterium leprae. This clinically manifests predominantly with neurological and cutaneous features. However, it may also manifest with a variety of autoimmune phenomena indicative of autoimmune diseases, such as Systemic Lupus Erythematosus (SLE) or Rheumatoid Arthritis. Infection with Mycobocterium leprae not only mimics lupus flares, but possibly may also act as a trigger for lupus reactivation; however, its relationship is still not fully understood and explored. We report a case that was diagnosed as leprosy but retrospective analysis revealed that it was probablythe initial manifestations of Lupus. During hospitalization the patient suddenly developed hypoxia and was found to have pulmonary haemorrhage. He was successfully managed with steroids, Mycophenolatemofetil along with other supportive treatment. Our case highlights the rare presentation of pulmonary haemorrhage in a male lupus patient and focuses on leprosy mimicking lupus.

Ultralow dose dentomaxillofacial CT imaging and iterative reconstruction techniques: variability of Hounsfield units and contrast-to-noise ratio

OBJECTIVE

The aim of this study was to evaluate whether application of ultralow dose protocols and iterative reconstruction technology (IRT) influence quantitative Hounsfield units (HUs) and contrast-to-noise ratio (CNR) in dentomaxillofacial CT imaging.

METHODS

A phantom with inserts of five types of materials was scanned using protocols for (a) a clinical reference for navigated surgery (CT dose index volume 36.58 mGy), (b) low-dose sinus imaging (18.28 mGy) and (c) four ultralow dose imaging (4.14, 2.63, 0.99 and 0.53 mGy). All images were reconstructed using: (i) filtered back projection (FBP); (ii) IRT: adaptive statistical iterative reconstruction-50 (ASIR-50), ASIR-100 and model-based iterative reconstruction (MBIR); and (iii) standard (std) and bone kernel. Mean HU, CNR and average HU error after recalibration were determined. Each combination of protocols was compared using Friedman analysis of variance, followed by Dunn's multiple comparison test.

RESULTS

Pearson's sample correlation coefficients were all >0.99. Ultralow dose protocols using FBP showed errors of up to 273 HU. Std kernels had less HU variability than bone kernels. MBIR reduced the error value for the lowest dose protocol to 138 HU and retained the highest relative CNR. ASIR could not demonstrate significant advantages over FBP.

CONCLUSIONS

Considering a potential dose reduction as low as 1.5% of a std protocol, ultralow dose protocols and IRT should be further tested for clinical dentomaxillofacial CT imaging.

ADVANCES IN KNOWLEDGE

HU as a surrogate for bone density may vary significantly in CT ultralow dose imaging. However, use of std kernels and MBIR technology reduce HU error values and may retain the highest CNR.

Efficacy of high-dose intra-dermal hepatitis B virus vaccine in previous vaccination non-responders with chronic liver disease

BACKGROUND

Hepatitis B virus (HBV) vaccination is essential in chronic liver disease (CLD), because it can help prevent acute-on-chronic disease, which has potentially fatal complications. Unfortunately, this group has a significant proportion of HBV vaccination non-responders. A variety of intra-muscular (IM) vaccination methods have been used in an attempt to remedy this poor-response, but with limited success.

AIMS

Herein is reported the safety and efficacy of high-dose intra-dermal (ID) HBV vaccination in CLD individuals who had failed previous IM standard and boost-dosing regimens.

METHODS

Forty-eight CLD individuals, known HBcAb negative, who had failed both a three-dose schedule of 40 μg IM vaccination, and boost dosing of either 40 or 80 μg IM, were identified, of which 42 completed the vaccination course. Each received a 40 μg ID total dose (20 μg per arm) during their clinic visits until a response was documented or a maximum of three doses had been administered. HBsAb titer ≥ 10 mIU/ml was regarded as an immunologic response; the intention was to achieve an optimum response of ≥ 100 mIU/ml.

RESULTS

Twenty-nine of forty-two (69%) individuals had an immunologic response, with 15 (51%) of the responders having the optimum response. No changes in serologic data occurred. No serious dermatologic reactions were observed. No differences between those who responded and those who did not were observed with regard to the presence of cirrhosis, diabetes mellitus, or chronic kidney disease.

CONCLUSIONS

High-dose ID HBV vaccination of previous CLD non-responders to the standard IM regimen with boost dosing is both safe and efficacious, and should be considered for all such groups.

Comparison of the clinical efficacy of a new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm fluoride to a commercially available sensitive toothpaste containing 2% potassium ion on dentin hypersensitivity: a randomized clinical trial

OBJECTIVE

This clinical study was designed to compare dentin hypersensitivity relief among subjects who brushed their teeth with a new toothpaste containing 8.0% arginine, calcium carbonate, and 1000 ppm fluoride as sodium monofluorophosphate (MFP) to subjects who brushed with a commercially available dentifrice containing 2% potassium ion as potassium nitrate over an eight-week period.

METHODS

Adult male and female subjects from the New Delhi, India area were required to present two teeth that exhibited dentin hypersensitivity, both to tactile stimulation using the Yeaple Probe and to air blast stimulation delivered by a standard dental unit syringe. After an examination of the oral soft and hard tissues, qualifying subjects were randomly assigned one of the study dentifrices and a soft-bristled toothbrush, and were instructed to brush their teeth for one minute, twice daily (morning and evening), using only the toothbrush and dentifrice provided. No other oral hygiene practices were permitted over the course of the study. After two, four, and eight weeks of product use, subjects returned to the dental clinic for follow-up examinations of tactile and air blast sensitivity of the baseline-designated hypersensitive teeth. Examinations of the oral soft and hard tissues were also performed at these follow-up visits.

RESULTS

Subjects who brushed with the new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm MFP exhibited statistically significant reductions (p < 0.05) in dentin hypersensitivity in response to tactile (36.2%, 33.1%, and 29.7%) and air blast (16.4%, 31.1%, 58.8%) stimuli when compared to the subjects who brushed with the 2% potassium ion as potassium nitrate dentifrice after two, four, and eight weeks, respectively.

CONCLUSION

The use ofa new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm MFP provides greater efficacy in reducing dentin hypersensitivity when compared to a dentifrice containing 2% potassium ion, as potassium nitrate, after two, four, and eight weeks of product use.

Comparison of the clinical efficacy in reducing dentin hypersensitivity of a new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm sodium monofluorophosphate to a commercially available toothpaste containing 1000 ppm sodium monofluorophosphate: an eight-week clinical trial on adults in New Delhi, India

OBJECTIVE

This clinical study evaluated relief from dentin hypersensitivity among subjects who brushed their teeth with a new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm fluoride as sodium monofluorophosphate (MFP) to subjects who brushed with a commercially available dentifrice containing 1000 ppm MFP over an eight-week period.

METHODS

Adult subjects from the New Delhi, India area, with two teeth that exhibited dentin hypersensitivity, both to tactile stimulation using the Yeaple Probe and to stimulation using an air blast delivered by a standard dental unit syringe, were screened for study enrollment. Qualifying subjects were randomly assigned one of the study dentifrices and instructed to brush their teeth for one minute, twice daily (morning and evening) with the provided dentifrice. Follow-up examinations for dentin hypersensitivity were conducted after two, four, and eight weeks of product use.

RESULTS

Subjects provided with the new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm MFP exhibited statistically significantly (p < 0.05) greater reductions in dentin hypersensitivity in response to tactile (81.9%, 90.5%, and 116.7%) and air blast (39.5%, 56.7%, and 76.7%) stimuli than subjects assigned the 1000 ppm MFP dentifrice after two, four, and eight weeks, respectively.

CONCLUSION

The use of a new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm MFP provides superior efficacy in reducing dentin hypersensitivity (p < 0.05) than a control dentifrice containing 1000 ppm MFP alone after two, four, and eight weeks of use.

Aggressive natural killer cell leukaemia: a rare and fatal disorder

Natural killer (NK) cell neoplasms, which include extra-nodal NK/T-cell lymphoma (nasal and extra-nasal) and aggressive NK cell leukaemia, are generally rare, but they are more common in people of Oriental, Mexican and South American descent. These neoplasms are highly aggressive, and show a strong association with Epstein-Barr virus. Aggressive NK cell leukaemia affects younger patients, who present with poor general condition, fever, and disseminated disease; they often die within a short time from systemic disease or complications such as multi-organ failure. Aggressive NK cell leukaemia must be distinguished from T-cell large granular lymphocyte leukaemia and indolent NK cell lympho-proliferative disorder, both of which are indolent. We present a case of young Asian male with aggressive NK cell leukaemia who presented with a poor general condition and disseminated disease. The patient had a rapidly progressive disease and died within weeks of diagnosis.

Unusual cause of weight loss in a patient with HIV-hepatitis C virus coinfection

Recombinant interferon α (IFN α), alone or in combination, is used extensively in the treatment of hepatitis C infection. IFN therapy is not free of side-effects and autoimmune thyroiditis is one of its rare side-effects. We present here a case of a patient with hepatitis C virus-human immunodeficiency virus coinfection on interferon therapy who presented with significant weight loss. He was found to have IFN-related autoimmune thyrotoxicosis and responded to antithyroid drugs and propanolol. Therefore, this case highlights that IFN-induced thyroiditis is an unusual side-effect and that during treatment, a thyroid-stimulating hormone assay should be performed at regular intervals (every 8-12 weeks).

Unusual cause of weight loss in a patient with HIV-hepatitis C virus coinfection

Recombinant interferon α (IFN α), alone or in combination, is used extensively in the treatment of hepatitis C infection. IFN therapy is not free of side-effects and autoimmune thyroiditis is one of its rare side-effects. We present here a case of a patient with hepatitis C virus-human immunodeficiency virus coinfection on interferon therapy who presented with significant weight loss. He was found to have IFN-related autoimmune thyrotoxicosis and responded to antithyroid drugs and propanolol. Therefore, this case highlights that IFN-induced thyroiditis is an unusual side-effect and that during treatment, a thyroid-stimulating hormone assay should be performed at regular intervals (every 8-12 weeks).

Leucocytoclastic vasculitis as a presentation of adenocarcinoma rectum

Vasculitis has been linked to several processes, like infections, drugs and allergic, rheumatologic and neoplastic diseases. Neoplasm-associated vasculitis described in the medical literature has mostly been reported in association with haemotological neoplasms. Adenocarcinoma of rectum presenting as leucocytoclastic vasculitis is rare. We present a case of a 43-year-old male with paraneoplastic leucocytoclastic vasculitis preceding the manifestation of adenocarcinoma rectum. The vasculitis subsided on resection of the rectal malignancy and the patient did not require steroid therapy thereafter.

Gangrenous sigmoid volvulus: a clinical study of 76 patients

BACKGROUND AND AIMS

This study investigated the clinical picture of gangrenous sigmoid volvulus presented by Indian patients to describe the various patterns of gangrene and to identify the risk factors leading to the very high mortality from this disease.

PATIENTS AND METHODS

A structured protocol including nine parameters was used to study risk factors in 76 patients treated at two major teaching hospitals in India. The clinical picture of patients at the two hospitals did not differ significantly.

RESULTS

Contrary to expectations, we found gangrene in 26% of cases extending beyond the area of constriction into the rectum/descending colon. This extension was sometimes patchy and had an ill defined line of demarcation, which may lead to an error in judgment and cause a failure of anastomosis, which can be fatal. Risk factors were age over 60 years, the presence of shock on admission and a history of previous episodes of volvulus.

CONCLUSION

This study identified three risks for survival. It is suggested that all patients with nongangrenous sigmoid volvulus undergo a recurrence-prevention procedure immediately or electively. We also found that extension of gangrene beyond the confines of the constriction is not uncommon, calling for caution on the part of the treating surgeon.

Pulmonary arteriovenous fistula presenting as multiple brain abscess

Pulmonary arteriovenous fisula is a rare condition in which there is abnormal connection between pulmonary arteries and veins. We describe this condition is an 18-year-old male who presented with cyanosis, clubbing, polycythemia and multiple brain abscesses. The patient was diagnosed as pulmonary arteriovenous fistula based on CT scan and on pulmonary angiography. The patient had a complete recovery after surgical drainage of brain abscess and excision of right upper lobe. After one year of follow up, there are no symptoms and there is complete reversal of cyanosis and polycythemia.

Torsade de pointes probably induced by sparfloxacin

Sparfloxacin is a new fluoroquinolone with potent antitubercular activity. We report a case of a 37 year old female who was on this drug as part of modified antitubercular therapy and developed torsade de pointes on this drug.

Profound thrombocytopenia in Plasmodium vivax malaria

In India, malaria is endemic and commonly caused by Plasmodium vivax and P. falciparum. Thrombocytopenia is a common finding in falciparum infection but is rare in P. vivax infection. We report profound thrombocytopenia in a 43-year-old female patient due to P. vivax infection. The platelet count was as low as 5 x 10(9)/liter, such severe thrombocytopenia has never been reported in vivax malaria.

Role of radionuclide perfusion study in cold solitary thyroid nodule for diagnosis of malignancy: a complimentary diagnostic modality to fine needle aspiration cytology

One hundred and forty eight subjects with euthyroid solitary thyroid nodules (STN) were taken up for radionuclide perfusion study. They were found to have a cold STN on 99mTc thyroid static scan. All had fine needle aspiration cytology (FNAC), and except for subjects with chronic lymphocytic thyroiditis, were subjected to surgery for tissue diagnosis by histopathology. The diagnostic findings in these patients of solitary thyroid nodules were correlated with the histopathology. Radionuclide perfusion study is considered useful to differentiate benign from malignant cold thyroid solitary nodules with high degree of sensitivity (95%) and specificity (87.9%).

Primary antiphospholipid syndrome in stroke in the young

Antiphospholipid syndrome is an uncommon cause of stroke. A 12 year old girl with this syndrome is reported who presented with thrombotic stroke and high titres of anticardiolipin (aCL) and lupus anticoagulant (LAC). The patient improved subsequently and was put on aspirin. The present report highlights the importance of screening for aCL and LAC in cases of stroke in young patients.

Superior sagittal sinus and inferior vena cava thrombosis with acute Budd-Chiari syndrome

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Syringomyelia--a complication of meningitis--case report

Syringomyelia following meningitis is a rare condition. This report summarizes the history of a 43 year old Indian male who developed arachnoiditis as a sequalae of tubercular meningitis. This later progressed to syringomyelia. The patient was treated with a syringo-subarachnoid shunt.