Homocysteine (Hcy) is a sulfur-containing amino acid with its only source in the human body being methionine. Three B complex vitamins (B ₆ , folate or B ₉ , and B ₁₂ ) participate in the metabolism of Hcy. Deficiency of these vitamins and the enzymes involved in its metabolism leads to elevated plasma Hcy levels (normal 5 - 15 μmol/l). Hyperhomocysteinemia (HHcy) is associated with several disorders. Hcy levels above 50 μmol/l is thought to be a risk factor for recurrent heart attacks and a value between 150 and 200 μmol/l may cause ischemic stroke. Levels above 300 μmol/l may induce mental deficiency. Several factors contributing to HHcy have been identified. These include lifestyle factors (smoking, alcoholism), drugs (phenytoin, valproate) and genetic causes (cystathionine β synthase deficiency). The various manifestations of HHcy are explained on the basis of oxidative damage and protein homocysteinylation, which cause damage to most tissues/organs leading to health complications and occurrence of various diseases. HHcy may affect major systems in the body like cardiovascular (coronary artery disease, myocardial infarction), central nervous (cerebrovascular accident, Alzheimer's, dementia) skeletal (increased risk of fractures), renal (low GFR), reproductive (risk of infertility), besides increasing the risk of hypothyroidism and cancer. The measures to prevent HHcy include consumption of nutritious foods, lifestyle changes (avoidance of smoking and alcohol) and supplementation of diet with vitamins - B ₆ , folate or B ₉ , and B ₁₂ .

Ultrasound (USG) is a simple, dynamic, and cost effective modality for investigation of a lump in the hand and wrist. We present sonographic findings of various lumps of the hand and wrist.

Introduction: Malaria is a major health problem in the tropics and poses a significant burden on health expenditure. Malaria is a common disease in rural India with high mortality and morbidity. Falciparum malaria is common in rural India and presents with protean manifestations, involving multiple systems and high mortality. Compared to benign malaria, Plasmodium falciparum malaria progresses to life-threatening complications, more so in rural India. The global case-fatality rate of falciparum infection is around 2 million deaths per year. Objective: To evaluate the incidence of thrombocytopenia in malaria, its variations in falciparum and vivax; and prognosis of patients with significant thrombocytopenia. Materials and Methods: Platelet count was done on a fully automated, quantitative, hematology Coulter analyzer (Name: I Count 3, Irish Company, 2010 model) for a sample collected from peripheral smear positive for malaria patient. Results: The mean platelet count in vivax infections wasis 120454.55/ml ranging from of 36,000 to 263,000 and in falciparum infections the mean platelet count was 118,200 with a range of 13,000-667,000. Conclusions: Low platelet counts observed in the course of malaria illness are transient and do not necessarily have prognostic implications or platelet infusions more so with the relatively benign course in Plasmodium vivax malaria.

Aim: Treg cells have been identified to play an important role in regulating T-cell responses and thereby affecting the Th1/Th2 cytokine balance. However, their role in periodontal disease is yet to be identified. Alterations in the expression of regulatory T cells in periodontal tissues could result in a change in their systemic levels. The aim of the study was to identify the regulatory T-cell subsets in systemic circulation and to compare their levels in patients with periodontal health and disease. Materials and Methods: Thirty-five peripheral blood samples were collected from each of two groups of patients (periodontal health: Group A, and periodontal disease: Group B). The samples were processed for flow cytometric analysis to detect and compare the expression of Treg cells (regulatory T cells). Statistical analysis was done using the Student's t test. Results: The mean Treg cells for the health group (Group A) was 311,724 cells/ml with a standard deviation of 250,411. The mean Treg cells for the disease group (Group B) was 260,809 cells/ml with a standard deviation of 187,900. P value was 0.508, which is statistically not significant. Conclusion: There is no statistically significant difference between Treg cell levels in periodontal health and disease, with respect to systemic circulation, although there is a slight decrease in levels in periodontitis compared to health. Apart from Th1/Th2 cells, the regulatory T cells may also contribute to the overall T-cell phenotype. Further studies are needed to confirm this hypothesis.

Objective: The aim of the present study was to evaluate the influence of a base on coronal microleakage of post-prepared teeth. The objectives are to compare the degree of coronal microleakage of apical fill of post-prepared teeth with and without the use of zinc oxide eugenol (ZOE) cement base, using scanning electron microscope. Materials and Methods: Sixty maxillary teeth were divided into three groups, post-space was prepared, and coronal micro-leakage checked by using methylene blue dye in three groups: (1) with ZOE, (2) without ZOE, (3) sticky wax. Results: The leakage of methylene blue dye observed was minimum in Group A (both linear and lateral), moderate to severe in Group B, and least in Group C. Conclusion: The leakage of methylene blue dye was minimum with 2 mm of ZOE base. Hence, it is always advisable to have some sealing between the post- and gutta-percha.

Benign fibrous histiocytoma is a rare tumor that most commonly involves the wing of ileum. Only a few cases have been reported in the literature. The olecranon process of the ulna is an uncommon site. We report a 35-yr-old female who presented with swelling in the elbow region including the forearm, a condition since two years. The radiological findings suggested a diagnosis of a giant cell tumor but the histological findings supported a diagnosis of benign fibrous histiocytoma. Resection of the tumor and reconstruction of the elbow was done with the fibula as a spacer due to wdisinclination of the patient for a custom-made prosthesis.

Nodular hidradenoma is a variant of benign cutaneous adnexal tumors which arises from eccrine sweat glands. They occur frequently on the scalp, face, abdomen, and extremities. The clinical appearance of this lesion is not specific and differential diagnosis can only be done after complete removal of the lesion. We report a case of nonhealing ulcer on anterior abdominal wall in a 35 year male. The ulcer occurred following excision of a recurrent anterior abdominal wall swelling of 4 year duration. Wedge biopsy was done in this institution and it was inconclusive. The ulcer was managed with antiseptic dressing, followed by skin grafting. Patient developed recurrent ulcero-proliferative lesion involving the same area in 3 months period. Wide excision of the ulcer revealed features of nodular hidradenoma. Nodular hidradenoma is reported rarely.

Over a period of 5 years, 4 cases of parasitic twins with varied clinical presentations were treated. One case presented with an accessory limb near gluteal region with caudal duplication. Two cases presented as localized mass lesions; one in the epigastrium and another in the gluteal region. Yet another case presented with accessory limb and a mass in the dorsal paraspinal region. Histopathology of these cases revealed presence of mature teratomatous elements and representation from varied tissues suggestive of parasitic twinning. Management of these cases needs to be tailored as per the anatomy and may need staged correction.

Gastroschisis is a rare congenital abdominal wall defect that requires prompt surgical correction. It almost exclusively occurs in infants of mothers younger than 25 years of age. The overall incidence of gastroschisis is 1 in 10,000 live births. It is characterized by normal umbilical cord insertion with defect being extra-abdominal through which abdominal contents protrude. There is no covering sac and the size of the defect is less than 4 cm. Here, we report a case of gastroschisis occurring in a 22-year-old female.

Cystadenoma is an uncommon, benign cystic epithelial neoplasm containing epithelium-lined papillary projections into the cystic spaces. A 45-year-old female presented with a swelling on the left side of the roof of her mouth. Clinically, the lesion was nontender, soft, and fluctuant. A fine-needle aspiration biopsy was suggestive of a minor salivary gland neoplasm. An excision biopsy showed characteristic features of cystadenoma. This paper highlights its cytological and histopathological features with differential diagnosis. Cystadenoma of the palate is rare with very few earlier reports.

Papillon-Lefèvre Syndrome is a rare autosomal recessive disorder with an onset usually by 2-3 years of age. The disease is mainly characterized by severe early onset of periodontitis, and hyperkeratosis characteristically involving the palms and soles and sometimes the knees, elbows, knuckles, and back. Periodontitis affects both the primary and secondary dentitions, resulting in premature tooth loss of both dentitions. The primary teeth erupt at the expected age and in the normal sequence. The teeth are typically of normal form and structure. Eruption of the primary dentition in to the oral cavity is accompanied by severe gingival inflammation and generalized aggressive periodontitis. Chewing can be painful due to tooth mobility. With loss of the primary dentition, gingival inflammation resolves. After the eruption of secondary teeth, the same cycle of events begins and without treatment most of the secondary teeth may be lost at an early age. Orthodontic treatment in periodontal compromised cases is most challenging, light forces and controlled mechanics are important for adjunctive orthodontic treatment.

Gemination and talon's cusps are rare developmental dental anomalies affecting both primary and permanent dentitions. Talon's cusps normally occur on the palatal surface of permanent maxillary incisors, whereas gemination is more common in the primary dentition. The purpose of this article is to report an uncommon case of talon's cusp on a geminated primary maxillary lateral incisor, including details of the clinical and radiographic findings and treatment in an 8-year-old girl.

Cancrum oris or noma is a rapidly spreading gangrenous stomatitis which occurs chiefly in debilitated or malnourished children, destroying the soft and hard tissue structures. Its fulminating course causes progressive and mutilating destruction of the affected tissues. As most patients with noma do not report until the disease is at an advanced stage, its onset and progression still remains a mystery. Survivors of this disease suffer severe facial deformity due to loss of facial tissues and scarring. We report a case report of noma highlighting its onset and progression, the extent of tissue necrosis and its management with an emphasis on the need for early diagnosis and prompt treatment.

Cleft lip and palate is a common craniofacial anomaly, requiring complex multidisciplinary treatment and having lifelong implications for affected individuals. The management starts soon after birth and involves a series of treatments during the first 20 years of life. The importance of the dentition and contribution of the orthodontist to the care of cleft patients from infancy to adulthood are presented. Close communication between orthodontists and surgeons is emphasized. The orthodontic treatment plan is developed around the anatomic, functional, and developmental needs of the patient. Despite great progress towards a better understanding of cleft lip and palate, as yet there is no accepted consensus on the management strategy. This article outlines the multidisciplinary approach to the management of the cleft lip and palate patients.