Management of Cervically Fractured Central Incisors: A Multidisciplinary Approach

Introduction:

Fracture of tooth structure at or below the gingival margin compromises rehabilitation and hampers esthetics and function.

Management:

Management of such cases by a post-core and crown restoration, or periodontal surgery or orthodontic extrusion alone may not always suffice in attaining a good result.

Case Report:

A multi-disciplinary approach which includes all of the above mentioned procedures helps in long term success.

Conclusion:

Careful case evaluation, treatment planning and meticulous attention to detail are the keys to the best treatment outcome.

Ultrasound-guided injection for plantar fasciitis: A brief review

Plantar fasciitis (PF) is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US) imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation.

P21-activated kinase 1 (Pak1) signaling influences therapeutic outcome in pancreatic cancer

BACKGROUND

Therapeutic resistance to gemcitabine in pancreatic ductal adenocarcinoma (PDAC) is attributed to various cellular mechanisms and signaling molecules that influence as a single factor or in combination.

DESIGN

In this study, utilizing in vitro p21-activated kinase 1 (Pak1) overexpression and knockdown cell line models along with in vivo athymic mouse tumor xenograft models and clinical samples, we demonstrate that Pak1 is a crucial signaling kinase in gemcitabine resistance.

RESULTS

Pak1 kindles resistance via modulation of epithelial-mesenchymal transition and activation of pancreatic stellate cells. Our results from gemcitabine-resistant and -sensitive cell line models showed that elevated Pak1 kinase activity is required to confer gemcitabine resistance. This was substantiated by elevated levels of phosphorylated Pak1 and ribonucleotide reductase M1 levels in the majority of human PDAC tumors when compared with normal. Delineation of the signaling pathway revealed that Pak1 confers resistance to gemcitabine by preventing DNA damage, inhibiting apoptosis and regulating survival signals via NF-κB. Furthermore, we found that Pak1 is an upstream interacting substrate of transforming growth factor β-activated kinase 1-a molecule implicated in gemcitabine resistance. Molecular mechanistic studies revealed that gemcitabine docks with the active site of Pak1; furthermore, gemcitabine treatment induces Pak1 kinase activity both in vivo and in cell-free system. Finally, results from athymic mouse tumor models illustrated that Pak1 inhibition by IPA-3 enhances the cytotoxicity of gemcitabine and brings about pancreatic tumor regression.

CONCLUSION

To our knowledge, this is the first study illustrating the mechanistic role of Pak1 in causing gemcitabine resistance via multiple signaling crosstalks, and hence Pak1-specific inhibitors will prove to be a better adjuvant with existing chemotherapy modality for PDAC.

Bovine carriers of Anaplasma marginale and Anaplasma bovis in South India

Carriers of bovine anaplasmosis in Northern Kerala, South India were detected using conventional microscopical and molecular techniques. PCR-RFLP and nested PCR techniques were used for detection of Anaplasma marginale and Anaplasma bovis respectively and the PCR products were confirmed by sequencing. Out of 150 samples tested, 25 were detected positive for A. marginale and five for A. bovis based on molecular tests. The inclusion bodies of A. marginale could be detected by microscopy in two blood smears after staining by giemsa while acridine orange staining detected three smears positive. The data clearly suggest the higher sensitivity of molecular techniques for diagnosis of these diseases.

Haemoprotozoa of cattle in Northern Kerala, India

A cross-sectional study was conducted using 150 blood samples collected from apparently normal / healthy crossbred cattle of Northern Kerala, South India, for detection of haemoprotozoan infections using staining techniques (Giemsa and Acridine Orange) and specific PCR. Theileria like piroplasms and Babesia bigemina were the only protozoan organisms detected in blood smears. Polymerase chain reaction using specific primers revealed amplification of products specific for Trypanosoma evansi (34.6%), Theileria sp. other than T. annulata (16%) and B. bigemina (0.6%). The higher prevalence rate of Trypanosoma evansi indicated that the subclinical parasitism can be due to higher prevalence of tabanid flies. The study also revealed the presence of a theilerial piroplasm other than T. annulata in North Kerala, which needs further investigation.

Short-term culture of peritoneum explants confirms attachment of endometrium to intact peritoneal mesothelium

OBJECTIVE

To evaluate the initial adhesion of endometrium to the peritoneum.

DESIGN

Descriptive study using light and confocal laser-scanning microscopy, immunohistochemistry, and transmission electron microscopy.

SETTING

University-based laboratory.

PATIENT(S)

Women without endometriosis undergoing surgery for benign conditions.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Explants of peritoneum (n = 20), prepared from four patients, were cultured for 1 hour with mechanically dispersed proliferative or secretory endometrium. Peritoneum was cultured with endometrium from the same patient. Specimens were fixed and serially sectioned for hematoxylin and eosin stain, immunohistochemistry using an anti-cytokeratin monoclonal antibody, and transmission electron microscopy.

RESULT(S)

In 17 of 20 explants, endometrium was adherent to intact mesothelium. There was no evidence of transmesothelial invasion at any sites of attachment. Although in most cases endometrium was adherent to mesothelium via endometrial stroma, there were many sites of endometrial epithelium-mesothelium attachment. Confocal laser scanning microscopy demonstrated an intact monolayer of cytokeratin-positive cells below the sites of endometrial implantation. Transmission electron microscopy demonstrated intact, viable, mesothelial cells below sites of attachment.

CONCLUSION(S)

This study demonstrates that endometrium rapidly adheres to intact peritoneal mesothelium. In addition, this study demonstrates that endometrial epithelial cells, as well as stroma, can attach to mesothelium. Further studies are needed that characterize the mechanism of endometrial-mesothelial cell adhesion.

Effects of malaria infection on pregnancy

A study of the effects of malaria infection on the progress and outcome of pregnancy was carried out during 1987-88 in the Medical College Hospital, Surat, Gujarat. Pregnant women were highly susceptible to the infection (SPR, 57.7) compared to the general population (SPR, 18.6). P. falciparum infection was predominant (62.4%). The infection rate was also found to be higher (SPR, 72.2%) in second trimester compared to first and third semesters. Primigravidae seemed to be at a greater risk as the mean parasitaemia level was higher (39%) and the outcome poor as compared to multigravidae (29%). Infection during pregnancy caused severe maternal complications like abortion (9.7%), premature labour (59.6%), and still-births (5.7%), which were higher in P. falciparum infection. Microcytic anaemia combined with dimorphic anaemia was predominant in the infected group (89.5%). Cord blood in 4 cases and on baby's blood were found positive for malaria parasite, showing transplacental passage of malaria parasites, which is rare. The infection was found to have a definite bearing on the low birth weight of babies. Chemoprophylaxis could obviate much of the complications.