Periodontal disease is a multifactorial disease, the origin of which remains obscure. However, the manifestation and progression of periodontitis is influenced by a wide variety of determinants including social and behavioral factors, systemic factors, environmental and genetic factors. Periodontal tissue integrity is dependent on the adequate intake of proteins, carbohydrates, fats, vitamins, and mineral salts. Chronic deficiencies in the availability of one or more of these nutrients are expected to produce pathological alterations in the expression and progression of periodontal disease. Folic acid, also known as vitamin B ₉ or folacin, is one such vitamin that is essential for numerous bodily functions ranging from nucleotide biosynthesis to the remethylation of homocysteine. Folic acid deficiency causes absence of keratinization of gingival surface, decreased resistance to infection, necrosis of gingiva, periodontal ligament, and alveolar bone destruction in animals and humans. This may be accompanied by ulcerative glossitis and cheilitis. Repair and maintenance of periodontal tissues generates a high turnover rate of squamous epithelium and without folic acid, epithelial cells do not divide properly. Folic acid deficiency is the most common nutrient deficiency in the world. Organic nitrites, nitrous oxide, cyanates, and isocyanates found in cigarette smoke have been shown to interact with folic acid, transforming them into biologically inactive compounds and thereby leading to lower folic acid levels in serum, red blood cells, and respiratory tract. Folic acid supplementation as an adjunct in the management of periodontal disease in smokers will prove to have beneficial effect on the periodontal tissues during repair and turnover.

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Hypomelanosis of Ito, also known as Incontinentia Pigmenti Achromians of Ito (IPA), is a rare cutaneous syndrome clinically characterized by macular hypopigmented whorls, patches, and streaks either unilateral or bilateral following lines of Blaschko. These skin lesions become apparent at birth or during childhood and normally are present on the trunk, occasionally on the extremities, and rarely on the face. Most patients have multisystem involvement and may show chromosomal mosaicism, the most common being neurological, muscular, skeletal, and ocular. We present a male child of 5-years-old with hypopigmented whorls and patches along the lines of Blaschko present on both sides of the trunk since birth. The child had no other systemic abnormality. The importance of this cutaneous condition and its association with other system involvement has been emphasized in this article.

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Osseointegration is the treatment modality opted in the rehabilitation of partially or fully edentulous patients. However, the surrounding tissues may be subject to inflammatory conditions, similar to periodontal disease, and so requires maintenance. The dental personnel should have current knowledge about methods of safely instrumenting implants and knowledge of available products, which could be safely recommended to patients to initiate effective home care of implants. It can be challenging to achieve effective oral hygiene around dental implants over the long term, and the patient, dentist, and dental hygienist must exercise considerable effort to achieve the desired results. This article discusses the background, etiology, diagnosis of peri-implant diseases, maintenance, care of osseointegrated implants.

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Fungal species are not frequently encountered in an immunocompetent host. Invasive aspergillosis typically occurs in severely immunocompromised patient. Aspergillus infection of breast and chest wall are rarely encountered in an immunocompetent as well as in immunocompromised host. Till date only 13 cases of fungal infection of breast and chest wall have been reported in the literature. This report presents a case of aspergillosis of bilateral breast and chest wall in an immunocompetent male, clinically mimicking breast cancer. Diagnosis was achieved by fine-needle aspiration cytology and subsequently Aspergillus flavus was identified on fungal culture. The patient was successfully treated with voriconazole. Prompt diagnosis by cytology and appropriate treatment is necessary to prevent adverse outcome. Here, we present this rare case of fungal infection of breast and chest wall with relevant review of the literature.

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Regional odontodysplasia is a rare nonhereditary developmental anomaly affecting dental tissues derived from both ectoderm and mesoderm. It has characteristic clinical, histologic, and radiographic findings. Although various factors seem to be associated with this condition, the etiology remains uncertain yet. Because of its characteristics findings, this condition is diagnosed easily but remains difficult to treat. Various schools of thought exist regarding the treatment. However, the treatment decision varies from case to case. The aim of this paper is to elaborate the condition with a review of literature and to discuss the controversies existing over the treatment options so as to provide successful treatment outcome.

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Cysts and cavities are commonly encountered lesions in the lung on chest radiography and chest computed tomography. They are usually of congenital origin in children. Common causes of acquired lung cysts during childhood include necrotizing pneumonias, trauma, cystic fibrosis and kerosene poisoning. We report here a toddler who presented with bronchopneumonia, was treated for the same, then found to have a left lower lobar lung cyst, which disappeared after 2 months with appropriate conservative management.

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Context: The most common concern among terminally ill patients in palliative care is death, which is often perceived as a psychosocial stigma. The knowledge, attitudes, beliefs, and experiences regarding death influence both the delivery of palliative care and its outcomes. Aims: This study was conducted with an aim to perform a quantitative analysis of research publications in palliative care journals for articles on death and bereavement care (DBC). Settings and Design: Systematic review of palliative care journals. Materials and Methods: Twelve palliative care journals were searched for articles related to "death" in the title of the articles published in 2009 and 2010. The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles category was further classified according to study designs. Statistical Analysis: Descriptive analysis using frequencies and percentiles was done using SPSS for Windows version 11.5. Results: The overall reporting rate among all journals was 5.27% (96/1821), and Palliat Support Care had the highest reporting rate of 14.4% (17/118), followed by BMC Palliat Care with 9.3% (4/43) and Palliat Med with 7.4% (16/216). Conclusions: The overall reporting rate for DBC articles in palliative care journals was very low, and very few randomized clinical trials and systematic reviews were found. The study findings indicate a lack of adequate evidence base for DBC.

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Chromoblastomycosis is an uncommon chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. We present here two cases of chromoblastomycosis, one with an atypical presentation. The diagnosis was made by demonstration of sclerotic bodies on the histopathological examination of skin biopsies and isolation of Fonsecaea pedrosoi on culture in both of them. Chromoblastomycotic skin lesions particularly atypical ones may be confused with other clinical conditions involving skin and are presented here for their academic interest.

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Background: To describe detailed epidemiological analysis of an outbreak of suspected Crimean-Congo hemorrhagic fever (CCHF) based on available clinicopathological and verbal autopsy findings of the cases and epidemiological intervention taken for prevention and control of the same in a rural setting of India. Aims: To define clinical syndrome, to find-out probable etiology, source of infection, mode of transmission and to develop a control and prevention strategy to halt further spread of unknown fatal febrile illness. Settings and Design: It was an outbreak investigation in affected small village of Gujarat, applying few principles of descriptive epidemiology in rural settings. Materials and Methods: Various information obtained by in-depth interviews, verbal autopsy tools, available medical records and house to house active case finding survey. Statistical Analysis: Microsoft Excel 2007 was used for statistical analysis. Results: The relevant information revealed that it as clustering of unknown hemorrhagic fever in households infested by hard tick population with a potential to further outbreak in and around nearby area. All secondary cases had strong epidemiological link with the index case. The illness was characterized by high grade fever with chills, headache and body-ache for short duration of 3-6 days followed by varying degree of hemorrhagic tendency, hepatic and renal involvement. The case fatality rate was very high (60%) and probable length of the incubation period was 9-15 days. Conclusions: It was a probable outbreak of a viral hemorrhagic fever, clinically compatible with CCHF cases. Effective removal of hard tick population from the village by Malathion spray had played a significant role in control and prevention of further cases.

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Objective: The purpose of this study was to determine and compare the prevalence and presentation of developmental defects of the enamel (DDE) in the mixed and permanent dentition of healthy school children residing in hills. Materials and Methods: A total of 1188 healthy school children were examined using modified DDE criteria for recording enamel defects. Results: The overall prevalence of DDE of any type was (51.3%) in both mixed and permanent dentition. Diffuse opacity was (25.3%) the most common defect and demarcated opacity was (23.1%) and whereas, enamel hypoplasia was the least prevalent defect with prevalence of (2.9%). Conclusion: The study population showed a high prevalence of DDE in primary as well as in the permanent dentition, reflecting the current increasing trend of this condition, which should be considered as a significant public health problem.

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Lipomatous uterine tumors are unusual benign neoplasms. Here, we report a case of lipoleiomyoma in a 45-year-old perimenopausal woman who presented with lower abdominal pain and distension. Ultrasonography revealed a small hyperechoic mass and multiple leiomyomas within the pelvic cavity. Gross examination of the hysterectomy specimen revealed multiple subserosal leiomyomas. On microscopy, presence of mature fat admixed with smooth muscle was noted, which was an incidental finding consistent with a uterine lipoleiomyoma. Hence, it emphasizes the importance of histopathology in the confirmation of the diagnosis. The importance of this case lies in its rarity and its enlistment in the differentials of lipomatous tumors in the pelvic cavity. We seek to discuss such a distinct entity.

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Vertebral artery arises from the upper surface of the first part of subclavian artery on both sides. The morphological variations of the vertebral artery are of immense importance in surgery, angiography and all non-invasive procedures. During the routine dissection of a male cadaver aged about 65 years, we observed a variation in the branching of arch of aorta. The arch of aorta gave off four branches-brachiocephalic trunk, left common carotid artery (CCA), left vertebral artery (LVA) and left subclavian artery. LVA was arising between left CCA and left subclavian artery.The knowledge of variations in the vertebral artery is of great clinical interest to the neurosurgeon and radiologist for diagnostic investigation and surgical procedures of the neck.

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Encephalotrigeminal angiomatosis, more commonly known as Sturge-Weber syndrome (SWS), is a rare disorder occurring sporadically with a frequency of 1:50,000. It is characterized by facial nevus, seizures, hemiparesis, intracranial calcification, and mental retardation. We report here a young infant presenting with port-wine stain of one side of the face and transient hemiparesis (stroke-like episode) of the opposite side, seizures, and intracranial calcification, suggesting the diagnosis of SWS. The child reported here presented with a stroke-like event at a relatively young age, which is unusual. The baby was given supportive therapy.

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Background: Malaria threatens the lives of under-five in rural Nigerian families. Although factors that influence malaria in under-five are manifold, family bio-social factors may contribute to the variability of the clinical picture. Aim: To determine family bio-social variables associated with severe malaria among under-five children in a resource-poor setting of a rural hospital in Eastern Nigeria. Materials and Methods: A cross-sectional study was carried out on the families of under-five managed for malaria. Data extracted included family bio-social variables and diagnosis. An under-five child was defined to have malaria if the mother gave complaints of fever, vomiting and other symptoms suggestive of malaria, had body temperature exceeding 37.5΀C with the asexual forms of Plasmodium falciparum detected on the peripheral blood film. Severe malaria is the malaria that presents with life-threatening features like severe anemia and cerebral malaria. Results: The prevalence of severe malaria was 31.8%. The family bio-social variables significantly associated with severe malaria were maternal low level of education (P = 0.031), family size >4 (P = 0.044), low social class of the family (P = 0.025), non-living together of parents (P = 0.011), and poor access to health facilities (P = 0.038). The most significant predictor of severe malaria was non-living together of parents (P = 0.000, OR = 3.08, CI = 1.64-5.10). Conclusion: This study has demonstrated that some family bio-social variables are associated with severe malaria. These families should constitute at risk families that could be targeted for malaria interventional programs.

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