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   Table of Contents - Current issue
January-March 2021
Volume 9 | Issue 1
Page Nos. 1-45

Online since Thursday, March 4, 2021

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The parasites caught in-action: Imaging at the host–Parasite interface p. 1
Mohammed A Afifi
For many decades, scientists were unable to expose the invisible existence of the parasites in their living hosts, except by scarification and then dissection of the animal model. This process just demonstrates a dead parasite in a dead host. Using this approach, very limited information can be obtained concerning the dynamics of infection and the pathways utilized by the parasite to survive within a hostile host's environment. Introduction of ultra-high-speed imaging techniques, with a time domain of barely few microseconds or even less, has revolutionized the “in vivo dissection” of the parasites. Such methods provide platforms for imaging host–parasite interactions at diverse scales, down to the molecular level. These have complementary advantages and relative assets in investigating host–parasite interactions. Therefore, better elucidation of such interaction may require the usage of more than one approach. Precise in vivo quantification, of the parasite load within the host, and better insight into the kinetics of infection are the two main advantages of the novel imaging procedures. However, imaging parasite–host interplay is still a challenging approach due to many constraints related to the parasite biology, the tissue environment within which the parasites exist, and the logistic technical limitations. This review was planned to assist better understanding of how much the new imaging techniques impacted the recent advances in parasite biology, especially the immunobiology of protozoan parasites.
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Comparative evaluation of mineral trioxide aggregate pulpotomy and laser-assisted mineral trioxide aggregate pulpotomy: An original research article p. 7
Saurabh Satyarth, Ahmed Mansour Alkhamis, Hessah Fahad Almunahi, Malak Omar Abdulaziz Alsuhaymi, Hima Bindu Vadde, S Navaneet Senapathi, Ahmed Omar Shami, Reema Fahad Aldrewesh, Abhishek Singh Nayyar
Context and Aim: Formocresol has been used as the material of choice (gold standard) for pulpotomy procedures because of the ease of use but was discouraged due to its potential immune sensitization and mutagenic effects. Laser irradiation was first applied for pulpotomy procedure in the year 1985. Recently, diode lasers have been used for pulpotomy in primary teeth and have shown clinical success rates comparable to formocresol. The present in vivo study was carried out to compare the clinical and radiographic success rates of mineral trioxide aggregate (MTA) pulpotomy and diode laser-assisted pulpotomy in human primary molars. Materials and Methods: The present study was a randomized clinical trial in design wherein 40 primary teeth requiring pulpotomy treatment which met the selection criteria (clinical and radiographic) were divided into two groups, Group 1 (n = 20) wherein the pulpotomy was performed with MTA alone and Group 2 (n = 20) wherein laser-assisted pulpotomy was performed with MTA (L-MTA). The patients were recalled after 3, 6, and 9 months, respectively and evaluated clinically and radiographically. Statistical Analysis Used: The data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 22 (IBM corporation, Washington DC, United States). Descriptive statistics were used to analyze the data while the Pearson's correlation coefficient test was used to analyze the statistical correlation between the overall success rates observed in the clinical and radiographic findings of both the groups. P < 0.05 was considered statistically significant. Results: The clinical success rate in the MTA group was 90%, 84.21%, and 88.23% at 3, 6, and 9 months, respectively, with no clinical signs or, symptoms reported at the said follow-up visits while the radiographic success rate was found to be 85%, 84.21%, and 82.3%, respectively. On the contrary, the clinical success rate in the L-MTA group was found to be 95%, 94.74%, and 94.44% at 3, 6, and 9, months, respectively with the radiographic success rate reported being 90%, 89.47%, and 88.89%, respectively. Conclusion: The combination of diode laser and MTA yielded better clinical and radiographic success rates over the pulpotomy procedures done with the help of MTA alone, thereby, concluding that lasers may be considered as adjuvant alternatives for vital pulp therapy on human primary teeth.
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Cytological evaluation of palpebral lesions: An insight into its limitations aided with histopathological corroboration p. 12
Krishnendu Mondal, Rupali Mandal, Indranil Chakrabarti
Context: Eyelids by virtue of its unique histomorphology give rise to multitudes of different pathological conditions. Appropriate preoperative cytological diagnoses of these cases are necessary to determine their optimal therapy. Aims: The aims of this study were to evaluate the utility of various cytological techniques in diagnosing the definite pathology for palpebral lesions and thereby to highlight the drawbacks associated with cytology in this context. Materials and Methods: Fine-needle cytology with or without applying the aspiration was the preferable method. Ulcerated lesions were sampled through scrapings. Results: Totally 62 cases were examined. Cytologically, 22 lesions were diagnosed as nonneoplastic, 38 lesions were neoplastic, and nondiagnostic material was obtained twice. Malignant tumors predominated among the neoplastic cases. Basal cell carcinoma (BCC) was the most common malignancy observed. On histopathological corroboration, benign skin adnexal tumor was found to be the most frequently misinterpreted entity. Two (out of four cases) of those tumors were confirmed as melanocytic nevus and BCC. A single case of squamous cell carcinoma was also cytodiagnostically erred into sebaceous carcinoma. Conclusions: Cytologically palpebral pathologies, including the neoplastic ones, are at times vulnerable to misinterpretation. To avert such dilemma, it is better to readily excise any recurrent lesion, basaloid neoplasm, or any necrohemorrhagic lesion presumptive of overshadowing the neoplastic pathology underneath.
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Aerococcus-related infections and their significance: A 9-year retrospective study p. 18
Kamal Kant Sahu, Amos Lal, Ajay Kumar Mishra, George M Abraham
Introduction: Aerococcus spp. is a Gram-positive, catalase- and oxidase-negative, microaerophilic, nonmotile bacteria species rarely associated with human infections such as arthritis, bacteremia, endocarditis, and meningitis. The bacteria are also often confused with streptococci species or treated as a contaminant. Patients and Methodology: We conducted a retrospective, observational cohort study on all patients with Aerococcus spp. isolates in blood samples from July 2010 to June 2019. All categorical data were presented as counts and proportions, whereas continuous data were presented as median and interquartile ranges. Results: A total of 20 Aerococcus spp. isolates were identified over the study period of 9 years. Of these, Aerococcus urinae was isolated in 10 (50%), Aerococcus viridans in 6 (30%), and Aerococcus spp. (not speciated) in 4 (20%). The median age was 74.3 years (12 males and 8 females). The two most frequent presentations were fever (15 of 20) and altered mentation (6 of 15). Most of the patients (11 of 15) had at least one predisposing comorbidity related to the urinary tract system (8 with recurrent urinary tract infection, 7 with urinary incontinence, 3 with an indwelling catheter, 2 with renal stones, and 1 each with benign prostatic hyperplasia and a recent cystoscopy). The median white blood cell count was 18,426 cells/mL, median hemoglobin 10.96 g/dL, median platelet count 191,000 cells/μL, median blood urea nitrogen 28.6 mg/dL, and median creatinine 1.54 mg/dL. The urinary tract was the most likely source of bacteremia (10 of 20) based on either imaging findings (5 cases), positive urine culture for Aerococcus spp. (4 cases), or instrumentation history (1 case). In the rest, the cause of bacteremia could not be found. Endocarditis was suspected in 9 out of 20 patients. Transthoracic echocardiography/transesophageal echocardiography (TEE) confirmed 3 cases (2 aortic valves, 1 mitral valve and pacemaker). Interestingly, one case had septic emboli causing a right frontal stroke with a normal TEE and normal Doppler study for deep venous thrombosis. Blood cultures were positive in 35% (7 of 20) with polymicrobial growth, 3 with coagulase-negative staphylococci, 2 with Enterococcus faecalis, and the other 2 each with Diphtheroids spp. and Proteus mirabilis. Of the 20 cases, 9 and 10 required intensive care unit level care and vasopressor support, respectively. Most of the patients were treated for 5–14 days except the 3 cases with infective endocarditis (IE). The median hospital stay duration was 6.55 days with 2 fatalities (2 out of 20 patients). Conclusion: Old age and underlying urologic conditions are the best-known risk factors for Aerococcus spp. infection. Recent advances in diagnostic technology have led to an increase in detection of Aerococcus spp.-related infections. The rare occurrence of Aerococcus spp. in human infections and resultant lack of randomized control trials have resulted in a significant degree of clinical uncertainty in the management of Aerococcus spp. IE.
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Aesculus hippocastanum-derived extract β-Aescin and in vitro antibacterial activity p. 26
Salma L Dahash, Ourba K Abass, Myada M Abdul-Razaq, Hayder M Al-Kuraishy, Ali I Al-Gareeb
Objectives: The objective of this study was to investigate the antibacterial activity of β-aescin against common Gram-negative and Gram-positive bacteria. Materials and Methods: Agar well diffusion assay was used to determine the antibacterial activity of β-aescin against common Gram-negative and Gram-positive bacteria including Klebsiella pneumoniae, Escherichia coli, Staphylococcus epidermidis, Staphylococcus aureus, and Pseudomonas aeruginosa. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of β-aescin were evaluated by serial dilution method. Results: β-aescin led to significant antibacterial effects on the tested Gram-negative and Gram-positive bacteria compared to the negative control, P < 0.05 for K. pneumoniae and P. aeruginosa and P < 0.01 for E. coli, S. epidermidis, and S. aureus. On the other hand, β-aescin produced a comparable less antibacterial effect on K. pneumoniae, E. coli, and P. aeruginosa compared to the positive control, P < 0.01, whereas β-aescin illustrated a comparable effect with that of the positive control on Gram-positive S. epidermidis, P = 0.05. Furthermore, β-aescin illustrated a concentration-dependent antibacterial effect against Gram-positive S. epidermidis and S. aureus compared to the different concentrations, P < 0.01. MIC and MBC of β-aescin were high for Gram-negative bacteria and low for Gram-positive bacteria compared to MIC of the positive control. Conclusions: β-aescin is an effective antibacterial herb mainly against Gram-positive S. epidermidis and S. aureus in a concentration-dependent manner.
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The effect of intra-articular versus intravenous injection of mesenchymal stem cells on experimentally-Induced knee joint osteoarthritis p. 31
Aya Mostafa, Horeya E Korayem, Ereny Fekry, Somaya Hosny
Background: Osteoarthritis (OA) is a chronic degenerative debilitating disease, primarily affects joints, particularly weight-bearing areas. The surface layer of the articular cartilage breaks down and wears away leading to rubbing of bones, pain, swelling, and joint stiffness. Aim and Objectives: This study investigates the possible therapeutic effects of intra-articular versus intravenous injection of umbilical cord blood mesenchymal stem cells (UCB-MSCs) against mono-iodoacetate-induced OA of the knee joints in male albino rats, using histological and immunohistochemical techniques. Materials and Methods: Thirty male adult albino rats were randomized into five groups as follows: Group (I) and (II): Served as control. Group (III): Osteoarthritic group. Group IV: Osteoarthritic and intraarticularly-injected MSCs. Group V: Osteoarthritic and intravenously-injected MSCs. Animals were sacrificed 1 month after stem cell injection, the right knee was prepared for histological techniques (Hematoxylin and Eosin and Toluidine blue stains) and immunohistochemical technique (Bax stain). Prussian blue stain was used to assess homing of MSCs in Groups IV and V. Results: Knee joint surface was irregular, fissured, and fragmented in Group III. In Groups IV and V, affected area was filled with newly formed tissue. Toluidine blue showed a decrease in matrix staining in Group III compared to both control and MSCs-treated groups. Chondrocytes in Group III showed strong Bax immunoreactivity and this reaction decreased in Group IV and V; however, Group V immunoreactivity was more than Group IV. Prussian blue stain showed labeled UCB-MSCs in many chondrocytes in Group IV and few chondrocytes in Group V. Conclusion: Intraarticularly-injected UCB-MSCs showed better healing of knee OA than intravenously-injected UCB-MSCs.
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Isolated intramuscular cysticercosis of the biceps diagnosed on high-resolution ultrasonography p. 39
Reddy Ravikanth, Pooja Majumdar
High-resolution ultrasound clinches the diagnosis of intramuscular cysticercosis which is a rare finding. Here, we present a case of isolated intramuscular cysticercosis diagnosed on high-resolution ultrasonography in a 46-year-old gentleman who presented with a linear swelling in the flexor aspect of the left arm in the long head of the biceps.
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Reactivation of the epstein–Barr virus leading to acute liver failure in a patient living with HIV p. 41
Mohamed H Ahmed, Mansoor Raza, Sebastian Lucas, Dushyant Mital
We report a case of a 46-year-old female living with HIV since 2010 who was originally from Malawi and had settled in the UK in 2001. She was admitted to our hospital with confusion and quickly noted to have a decreased Glasgow Coma Scale of 10/15. Her biochemical parameters showed the presence of elevated liver function tests (LFTs), clotting abnormalities, and her ammonia were found to be >400 mmol/L with a severe metabolic acidosis (pH = 7.05). She was treated for HIV with combined antiretroviral therapy, namely tenofovir disoproxil fumarate, emtricitabine (FTC) and cobicistat boosted atazanavir 2 years previously and had normal LFTs at that time. Her HIV-1 viral load was 1400 copies/ml on admission after recently having an undetectable viral load 2 months previously, and her CD4 count was 480. Her relevant past medical history included insulin-dependent diabetes mellitus. Her other medications included insulin, ramipril, sertraline, amitriptyline, and zopiclone. Toxicology and viral hepatitis screen were negative. Epstein Barr virus (EBV) serology showed evidence of previous exposure, but she was found to have a very high EBV viral load of 55,000 copies/ml, which given her serology, was very likely to be a reactivation of EBV infection rather than a primary EBV infection. In the intensive care unit, the patient deteriorated and died very quickly. The postmortem examination showed extensive hepatic necrosis with collapse. To our knowledge, this is the first case report to show an association between EBV reactivation and fulminant hepatic failure in an individual living with HIV.
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Erratum: Students' awareness as an underlying factor for satisfaction and compliance p. 45

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