Richik Tripathi

Recent advances on the association of apoptosis in chronic non healing diabetic wound

Generally, wounds are of two categories, such as chronic and acute. Chronic wounds takes time to heal when compared to the acute wounds. Chronic wounds include vasculitis, non healing ulcer, pyoderma gangrenosum, and diseases that cause ischemia. Chronic wounds are rapidly increasing among the elderly population with dysfunctional valves in their lower extremity deep veins, ulcer, neuropathic foot and pressure ulcers. The process of the healing of wounds has several steps with the involvement of immune cells and several other cell types. There are many evidences supporting the hypothesis that apoptosis of immune cells is involved in the wound healing process by ending inflammatory condition. It is also involved in the resolution of various phases of tissue repair. During final steps of wound healing most of the endothelial cells, macrophages and myofibroblasts undergo apoptosis or exit from the wound, leaving a mass that contains few cells and consists mostly of collagen and other extracellular matrix proteins to provide strength to the healing tissue. This review discusses the various phases of wound healing both in the chronic and acute wounds especially during diabetes mellitus and thus support the hypothesis that the oxidative stress, apoptosis, connexins and other molecules involved in the regulation of chronic wound healing in diabetes mellitus and gives proper understanding of the mechanisms controlling apoptosis and tissue repair during diabetes and may eventually develop therapeutic modalities to fasten the healing process in diabetic patients.

Magnetic resonance imaging evaluation of temporomandibular joint and associated soft tissue changes following acute condylar injury.

PURPOSE This study evaluated the role of magnetic resonance imaging (MRI) in cases of acute condylar injury and assessed soft tissue damage such as disc displacement, capsular tear, and hemarthrosis within the temporomandibular joint (TMJ). PATIENTS AND METHODS This prospective study was conducted in 15 patients who presented with unilateral or bilateral condylar fracture or contusion with a unilateral or bilateral diagnosis of TMJ sprain/strain. Patients with trauma of less than 7 days previously with a unilateral or bilateral condylar fracture or contusion with a diagnosis of TMJ sprain/strain were included in the present study. The clinical diagnosis of TMJ sprain was made and further classified and graded according to the severity and type of injury. On confirmation of the diagnosis of condylar injury, patients underwent evaluation by MRI. All patients were treated by closed reduction of the condylar fracture and intermaxillary fixation for 14 to 21 days. RESULTS Of the 15 patients, 5 were children and 10 were adults. Of all 17 TMJ cases (2 bilateral, 13 unilateral), 2 condylar fractures were of the high variety and 13 were of the low variety. MRI diagnosis of disc displacement was established in 8 of 17 TMJ cases. There was a significant association between degrees of condylar injury and the MRI diagnosis of displaced disc and hemarthrosis. However, an MRI finding of capsular tear was not significantly associated with the degree of condylar injury. CONCLUSIONS Soft tissue changes of the TMJ can be predicted accurately by MRI and are in direct proportion to the severity of the condylar injury of the mandible. Among the soft tissue changes, disc displacement and hemarthrosis seem to affect the outcome of functional treatment.

Correlation between IL-7 and MCP-1 in diabetic chronic non healing ulcer patients at higher risk of coronary artery disease

Cytokines play an extremely important role in the pathogenesis of coronary artery disease (CAD) in which interleukin (IL)-7 is a major regulator of T-cell homeostasis which is conced in the stimulation of leukocyte-endothelial cell adhesion during inflammatory events. Circulating IL-7 is associated with activation of monocyte and natural killer cells, leading to enhanced production of inflammatory cytokines and chemokines observed in atherosclerosis and acute coronary syndromes. Plasma levels of IL-7, hs-CRP and monocyte chemoattractant protein (MCP)-1 were measured by an immunoenzymatic ELISA technique. Ninety neuropathic diabetic foot patients were divided into two groups: group B [those without CAD (n=45)] and group C [those with higher risk of CAD (n=45)]. Thirty-five healthy subjects were included as control (group H). Plasma concentration of IL-7, MCP-1 and hs-CRP were significantly higher in group C as compare with group H and B. Plasma IL-7 levels also showed significant positive correlations with plasma levels of hs-CRP and MCP-1. Abnormalities in lipid profile were also observed. In conclusion the positive correlation between plasma concentration of IL-7, MCP-1 and hs-CRP in diabetic foot patients observed herein, suggests a plausible role for IL-7 in the promotion of clinical instability in coronary artery disease.

Oral mucosal involvement in visceral leishmaniasis

Leishmaniasis affects both the visceral and cutaneous tissues in body. Oral Mucosal involvement in leishmaniasis is rare and is often overlooked. We present a case 17 year old boy from the north east region of Bihar who has a history of visceral leishmaniasis one year back, came to the department of oral surgery for treatment of persistent oral ulcers. Oral examination did not give any diagnostic information while systemic examination revealed enlarged spleen and low grade fever. Patient was screened for leishmaniasis by rK39 based immunochromatographic strip test which came to be positive. Biopsy of the ulcer as well as splenic and bone marrow aspirate confirmed the presence of leishmaniasis. Patient was administered Amphotericin B for 20 days following which significant clinical and haematological improvement followed.

Cystic lesion creating radiographic dilemma: An unusual case report

Dentigerous cyst is caused by fluid accumulation between the epithelium and the crown of an unerupted tooth. It grows by expansion of the follicle and is attached to the neck of the tooth. The radicular cysts are inflammatory jaw cysts at the apices of teeth with infected and necrotic pulps. These arise from the epithelial residues in the periodontal ligament as a result of inflammation, usually following death of the pulp. We present a case of a cystic lesion creating dilemma between radicular and dentigerous cyst.