Oral Lichen planus (OLP) is a common mucocutaneous disorder with a multifactorial aetiology, affecting the women more commonly than men. Most OLP are asymptomatic, except the atrophic and erosive forms.Till date many treatment modalities are implicated to treat this disorder, but no therapy is considered as the single most effective, without side-effects and remission of the lesion. As the treatment of OLP is challenging to the oral practitioners, here we report a case of successful management of extensive, symptomatic bullous and erosive oral lichen planus with a novel treatment protocol- oral minipulse therapy with betamethasone.
Alopecia; Auto-immune disease; Betamethasone; Reticular; Wickham striae
To investigate longitudinal changes in laminar and spatial
distribution of knee articular cartilage magnetic resonance imaging (MRI)
T2 relaxation times, in individuals with and
without medial compartment cartilage defects.
All subjects (at baseline n = 88, >18 years
old) underwent 3-Tesla knee MRI at baseline and annually thereafter for 3
years. The MR studies were evaluated for presence of cartilage defects
(modified Whole-Organ Magnetic Resonance Imaging Scoring – mWORMS),
and quantitative T1ρ and
T2 relaxation time maps. Subjects were
segregated into those with (mWORMS ≥2) and without (mWORMS ≤1)
cartilage lesions at the medial tibia (MT) or medial femur (MF) at each time
point. Laminar (bone and articular layer) and spatial (gray level
co-occurrence matrix – GLCM) distribution of the
T2 relaxation time maps were calculated.
Linear regression models (cross-sectional) and Generalized Estimating
Equations (GEEs) (longitudinal) were used.
Global T1ρ, global
T2 and articular layer
T2 relaxation times at the MF, and global
and articular layer T2 relaxation times at the
MT, were higher in subjects with cartilage lesions compared to those without
lesions. At the MT global T1ρ relaxation
times were higher at each time point in subjects with lesions. MT
T2 became progressively more heterogeneous
than control compartments over the course of the study.
Spatial distribution of T1ρ and
T2 relaxation time maps in medial knee OA
using GLCM technique may be a sensitive indicator of cartilage
deterioration, in addition to whole-compartment relaxation time data.
GLCM; Texture; Quantitative MRI; Cartilage defects; Laminar
The emergence of Nipah virus (NiV) infection into the pig population and subsequently into the human population is believed to be due to changes in ecological conditions. In Malaysia, A major NiV outbreak occurred in pigs and humans from September 1998 to April 1999 that resulted in infection of 265 and death of 105 persons. About 1.1 million pigs had to be destroyed to control the outbreak. The disease was recorded in the form of a major outbreak in India in 2001 and then a small incidence in 2007, both the outbreaks in West Bengal only in humans without any involvement of pigs. There were series of human Nipah incidences in Bangladesh from 2001 till 2013 almost every year with mortality exceeding 70 %. The disease transmission from pigs acting as an intermediate host during Malaysian and Singapore outbreaks has changed in NIV outbreaks in India and Bangladesh, transmitting the disease directly from bats to human followed by human to human. The drinking of raw date palm sap contaminated with fruit bat urine or saliva containing NiV is the only known cause of outbreak of the disease in Bangladesh outbreaks. The virus is now known to exist in various fruit bats of Pteropus as well as bats of other genera in a wider belt from Asia to Africa.
Nipah virus; NiV; Henipavirus; Fruit bats; Pigs; Encephalitis
The crystal structure of ethyl (6-hydroxy-1-benzofuran-3-yl)acetate sesquihydrate exhibits a one-dimensional hydrogen-bond motif consisting of (12) rings joined at water molecules located on a twofold rotation axis.
In the title hydrate, C12H12O4·1.5H2O, one of the water molecules in the asymmetric unit is located on a twofold rotation axis. The molecule of the benzofuran derivative is essentially planar (r.m.s. deviation for the non-H atoms = 0.021 Å), with the ester group adopting a fully extended conformation. In the crystal, O—H⋯O hydrogen bonds between the water molecules and the hydroxy groups generate a centrosymmetric R
6(12) ring motif. These R
6(12) rings are fused, forming a one-dimensional motif extending along the c-axis direction.
crystal structure; hydrates; O—H⋯O hydrogen bonds; C—H⋯π interactions; benzofuran
Fluorinated graphene oxide (FGO) is reported for the first time as a magnetically responsive drug carrier that can serve as a MRI and photoacoustic contrast agent, under pre-clinical settings, as well as a photothermal therapy Its hydrophilic nature facilitates biocompatibility. FGO as a broad wavelength absorber, with high charge transfer and strong nonlinear scattering is optimal for NIR laser-induced hyperthermia.
multifunctional graphene; MRI; photoacoustic; photothermal therapy; drug delivery
In the title compound, the mean plane of the cyclohexane ring is almost normal to the benzene ring and to the mean plane of the 1,2,4-thiadiazinane ring. In the crystal, molecules are linked by N—H⋯O hydrogen bonds, forming chains along , which are in turn linked via C—H⋯π interactions, forming sheets parallel to (010).
In the title compound, C14H19BrN2O2S, the 1,2,4-thiadiazinane ring adopts an envelope conformation with the N atom (attached to the sulfonyl group) as the flap, while the cyclohexane ring adopts a chair conformation. The mean plane of the cyclohexane ring is almost normal to the benzene ring and the mean plane of the 1,2,4-thiadiazinane ring, making dihedral angles of 70.4 (2) and 71.43 (19)°, respectively. Furthermore, the dihedral angle between the benzene ring and the mean plane of the 1,2,4-thiadiazinane ring is 4.91 (18)°. The molecular structure is stabilized by an intramolecular C—H⋯O hydrogen bond, which encloses an S(6) ring motif. In the crystal, molecules are linked by N—H⋯O hydrogen bonds into chains along [10-1], forming a C(6) graph-set motif. These chains are interconnected via C—H⋯π interactions, leading to chains along [-101], so finally forming sheets parallel to (010).
crystal structure; benzothiadiazine; hydrogen bonding; chirality
Colorectal cancer (CRC) progression is associated with suppression of host cell-mediated immunity and local immune escape mechanisms. Our aim was to assess the immune function in terms of expression of TNF, IFNG and FOXP3 in CRC.
Sixty patients with CRC and 15 matched controls were recruited. TaqMan quantitative PCR and methylation-specific PCR was performed for expression and DNA methylation analysis of TNF, IFNG and FOXP3. Survival analysis was performed over a median follow-up of 48 months.
TNF was suppressed in tumour and IFNG was suppressed in peripheral blood mononuclear cells (PBMCs) of patients with CRC. Tumours showed enhanced expression of FOXP3 and was significantly higher when tumour size was >38 mm (median tumour size; P=0.006, Mann–Whitney U-test). Peripheral blood mononuclear cell IFNG was suppressed in recurrent CRC (P=0.01). Methylated TNFpromoter (P=0.003) and TNFexon1 (P=0.001) were associated with significant suppression of TNF in tumours. Methylated FOXP3cpg was associated with significant suppression of FOXP3 in both PBMC (P=0.018) and tumours (P=0.010). Reduced PBMC FOXP3 expression was associated with significantly worse overall survival (HR=8.319, P=0.019).
We have detected changes in the expression of immunomodulatory genes that could act as biomarkers for prognosis and future immunotherapeutic strategies.
expression; DNA methylation; TNF; IFNG; FOXP3; survival
Molecular regulation of fatty acid desaturase (Fads) gene expression by dietary arachidonic (ARA) and docosahexaenoic acid (DHA) during early postnatal period, when the demand for long chain polyunsaturated fatty acids (LC-PUFA) is very high, has not been well defined. The objective of the current study was to determine regulation of liver Fads1, Fads2 and Fads3 classical (CS) and alternative transcripts (AT) expression by dietary ARA and DHA, within the physiological range present in human breast milk, in suckling piglets. Piglets were fed one of six milk replacer formula diets (Formula-reared groups, FR) with varying ARA and DHA content from days 3-28 of age. The ARA/DHA levels of the six formula diets were as follows (% total fatty acid, FA/FA): (A1) 0.1/1.0; (A2) 0.53/1.0; (A3-D3) 0.69/1.0; (A4) 1.1/1.0; (D2) 0.67/0.62; (D1) 0.66/0.33. The control maternal-reared (MR) group remained with the dam. Fads1 expression was not significantly different between FR and MR groups. Fads2 expression was down-regulated significantly in diets with 1:1 ratio of ARA:DHA, compared to MR. Fads2 AT1 expression was highly correlated to Fads2 expression. Fads3 AT7 was the only Fads3 transcript sensitive to dietary LC-PUFA intake and was up-regulated in the formula diets with lowest ARA and DHA content compared to MR. Thus, the present study provides evidence that the proportion of dietary ARA:DHA is a significant determinant of Fads2 expression and LC-PUFA metabolism during the early post-natal period. Further, the data suggest that Fads3 AT7 may have functional significance when dietary supply of ARA and DHA are low during early development.
Arachidonic acid; Docosahexaenoic acid; fatty acid desaturase gene; infant nutrition; piglet
For complete periodontal regeneration, delivery of growth factors in the local environment holds a great deal in adjunct to bone grafts. Platelet rich fibrin (PRF) is considered as second generation platelet concentrate, consisting of viable platelets, releasing various growth factors such as platelet-derived growth factor, vascular endothelial growth factor, transforming growth factor, insulin-like growth factor, epidermal growth factor and basic fibroblast growth factor. Hence, this case report aims to investigate the clinical and radiological (bone fill) effectiveness of autologous PRF along with the use of xenogenic bone mineral in the treatment of intra bony defects. Intrabony defect was treated with autologous PRF along with the use of xenogenic bone mineral. A decrease in probing pocket depth, gain in clinical attachment level and significant bone fill was observed at end of 6 months. The result obtained with the use of PRF may be attributed to the sustained and simultaneous release of various growth factors over a period of 7 days. In this case report, the positive clinical impact of additional application of PRF with xenogenic graft material in the treatment of periodontal intrabony defect was seen.
Intrabony defects; periodontal regeneration; platelet-rich fibrin; xenograft
Acute kidney injury (AKI) is common in intensive care unit (ICU) and carries a high mortality rate. Reliable and comparable data about the clinical spectrum of AKI is necessary for optimizing management. The study was conducted to describe epidemiology, etiology, clinical characteristics and outcome of AKI in critically ill patients without pre-existing renal disease, diagnosed using RIFLE criteria. We retrospectively analyzed data of 500 adult patients admitted to ICU with AKI or who developed AKI in ICU. Patients with pre-existing renal disease, renal transplant recipients were excluded. AKI was predominantly encountered in older males. Diabetes, hypertension, coronary artery disease were the most commonly prevalent comorbidities. Sepsis was the most common cause of AKI, accounting for 38.6% of patients. 24.4% belonged to risk class, 37.0% to injury class, 35.0% to failure class, 3% to loss and 0.6% to ESRD class of the RIFLE criteria. Renal replacement therapy (RRT) was required in 37.2% (n = 186) of patients. About 60% recovered complete renal function. Chronic kidney disease (CKD) was a sequel in 2.4% (n = 12) of patients. Average duration of ICU stay was 5.6 days. Crude mortality rate was 37.6% (n = 188). In critically ill patients without pre-existing renal disease, elderly age, male sex, type 2 diabetes along with a primary diagnosis of sepsis were most commonly associated with AKI. Majority of the patients’ recovered complete renal function.
Acute kidney injury; critically ill patients; end stage criteria; failure; India; injury; loss; risk; spectrum
Intraoperative bleeding causing poor visibility of surgical field is of major concern during functional endoscopic sinus surgery (FESS) and impaired visibility may result in many complications. The study aimed to compare surgical conditions for FESS during controlled hypotension provided by esmolol or nitroglycerine (NTG) under general anaesthesia. 52 adult patients of both sexes requiring FESS under general anaesthesia were randomly divided to receive either esmolol (group ESM, n = 26) or NTG (group NTG, n = 26) to provide controlled hypotension. Surgical condition was assessed by surgeon using average category scale (ACS) of 0–5, a value of 2–3 being ideal. In both groups mean arterial blood pressure (MABP) was gradually reduced till ACS for assessment of surgical condition (ACS) of 2–3 or lowest targeted MABP (60 mm of Hg) was achieved. Both the drugs produced desired hypotension and improved surgical condition by reducing operative field bleeding but ideal operative conditions were achieved at mild hypotension (MABP 75–70) in ESM group while same conditions were achieved at MABP of 69–65 mm of Hg in NTG group. Mean heart rate was significantly higher in NTG group as compared to ESM group. Blood loss was significantly less in ESM group. Both NTG and esmolol can be used safely to provide controlled hypotension during FESS. Both the drugs improved visibility of surgical field by reducing capillary bleeding. But esmolol offered better operative conditions with only minimal reduction in MABP. No reflex tachycardia and less intraoperative haemorrhage were additional advantages of esmolol.
FESS; Controlled hypotension; Esmolol; Nitroglycerine
Letrozole is used as first line drug in postmenopausal women with early-stage or advanced hormone-sensitive breast cancer. Letrozole has favourable tolerability profile when administered once daily and significant adverse reactions occur rarely. The objective of this report is to describe a case of eczematous skin eruption that occurred during letrozole treatment. A 61-year-old female patient was admitted with lump in the left breast. FNAC, HPE were done and the patient was diagnosed to have invasive ductal breast carcinoma. After a month of completing CT and EBRT, the patient was given 2.5 mg OD tab. letrozole at night. She developed itchy skin lesions over the right thigh that later generalised, at 6- weeks of treatment. The lesion has been defined as eczematous moderate to severe drug eruption. These lesions were attributed to letrozole therapy and recurred within 24h after rechallenge. Drug eruption is associated with many drugs but this is the first such report with letrozole. We suggest of being aware of such reactions during letrozole usage.
Breast carcinoma; Old age; Rechallenge
Emphysematous epididymo-orchitis is an uncommon, acute inflammatory process of epididymis and testis characterized by the presence of air within the tissue. Patient presents with fever, acute pain, swelling and tenderness in the scrotum. Imaging is needed for rapid accurate diagnosis and to differentiate it from other causes of acute scrotum such as testicular torsion. We report a case of emphysematous epididymo-orchitis with imaging findings on plain radiography, ultrasound, CT and MRI and a brief review of the literature.
Acute scrotum; computed tomography; emphysematous epididymo-orchitis; magnetic resonance imaging; ultrasound
Lithopaedion means a calcified Dead foetus and it is usually extrauterine. We report a case of 32 year old female who presented to us with right iliac fossa mass. On diagnostic laparoscopy, it was found to be Lithopaedion and the same was removed in toto through laparoscopic approach.
Lithopaedion; Fetus; Abdominal pregnancy; Laparoscopy
A Lingual thyroid is relatively rare. Of all ectopic thyroids 90 % are found to be Lingual thyroids. We report a case of 32 year old female who presented to us with history of mass on back of the tongue with history of dysphagia.The clinical, biochemical and radioisotope scanning confirms the diagnosis of lingual thyroid with hypothyroidism. Patient was treated with levothyroxine. After treatment, Lingual thyroid reduced in size and patient improved symptomatically.
Lingual thyroid; Levothyroxine
One piece mini implants are viable and predictable options to
conventional implants in areas of deficit bone width. These can be
placed without complex surgical augmentation procedures and are
cost effective. Four mini implants were placed in a 40 year old
female patient replacing her mobile mandibular anterior teeth.
Provisional restoration was given after 2 weeks followed by
individual ceramic crowns after 6 months. 5 year follow-up showed
aesthetic soft tissue contours and successful osseointegration. One
piece mini implants are viable treatment option in the aesthetic
management of partial edentulism especially in the mandibular
How to cite the article:
Mohan CS, Harinath P, Cholan PK, Kumar DL . Predictable aesthetic
outcome with immediate placement and early loading of one piece
mini implant - A 5 year follow-up case report. J Int Oral Health
Early loading; immediate placement; one piece mini implants; osseointegration
Health status of children and adolescents is determined to a larger extent by their nutritional status. There are no published studies available on the influence of thinness on childhood morbidity using new World Health Organization-body mass index (WHO-BMI) for age criteria.
This cross-sectional study was conducted in primary, high schools, pre-university and degree colleges at southern Karnataka for a period of 1 year.
Majority 6924 (53.6%) were in the age group of 15-19 years with the mean age of 14.2 ± 3.1 years. 6167 (47.7%) were males and 6749 (52.3%) were females. As per WHO growth standards for children between 5 and 19 years, taking BMI for age criteria into account, 9092 (70.4%) subjects were found to be normal, 3660 (28.3%) thin and 164 (1.3%) overweight/obesity. 8224 (63.7%) subjects were suffering from some sort of morbidities. Mean morbidities rank for subjects with thinness was found to be significantly higher compared with normal and overweight/obese subjects. Thinness was found to be the major predictor of morbidity age, sex and residing in rural areas.
Magnitude of thinness among children and adolescents was 28.3%. BMI for age criteria was found to be a significant predictor of childhood and adolescent morbidity.
Adolescent; body mass index for age criteria; childhood; morbidity; obese; overweight; thinness
To evaluate the efficacy of topical antiinflammatory agent (amlexanox 5%), along with topical antiseptic, analgesic, and anesthetic agent (benzalkonium chloride 0.01%, choline salicylate 8.7% and lidocaine hydrochloride 2%), in promoting ulcer healing, decreasing ulcer size, erythema, pain and recurrence in minor RAS.
Materials & Methods:
A randomized control trial was conducted on 100 patients of RAS who fulfilled the inclusion criteria. The number, size, erythema and pain with the ulcer were recorded. Visual analogue scale (VAS) and erythema scale were used to record pain and erythema. 50 patients comprising the study group received anti inflammatory paste (amlexanox 5%) applied four times daily and the control group of 50 patients received topical antiseptic, analgesic, and anesthetic agent (benzalkonium chloride 0.01%, choline salicylate 8.7% and lidocaine hydrochloride 2%) paste, patients were evaluated after 3rd, 6th, 9th and on 30th, 60th day for recurrence.
The study group had reduction in ulcer number, size; erythema, pain and frequency of ulcers during follow up. The healing period and recurrence of ulceration reduced in both the groups but the study group had significant reduction in 30th and 60th day follow up for recurrence of ulcers.
Amlexanox 5% can reduce the frequency, duration and symptoms associated with the aphthous ulcers with no sideeffects attributed to the drug.
How to cite the article:
Darshan DD, Kumar CN, Kumar AD, Manikantan NS, Balakrishnan D, Uthkal MP. Clinical study to know the efficacy of Amlexanox 5% with other topical Antiseptic, Analgesic and Anesthetic agents in treating minor RAS. J Int Oral Health 2014;6(1);5-11.
Amlexanox; recurrent aphthous stomatitis (RAS); visual analogue scale (VAS)
Hyperglycemia induced generation of free radicals and consequent development of oxidative stress by polyol pathway is one of the crucial mechanisms stirring up development of diabetic complications. We evaluated influence of ten vegetables’ juice on polyol pathway along with their antioxidant and antioxidative stress potentials.
Materials and Methods:
Aldose reductase activity was determined utilising goat lens and human erythrocytes. In goat lens, utilization of nicotinamine adenine dinucleotide phosphate (NADPH) and aldose reductase inhibition was assayed. In human erythrocytes, sorbitol formation was measured as an index of aldose reductase activity under normoglycemic and hyperglycemic conditions. Ability of juices in inhibiting oxidative damage to deoxyribose sugar and calf thymus DNA and inhibitory activity against hydrogen peroxide induced hemolysis of erythrocytes was also analysed. Phytochemical contents like total polyphenol, total flavonoid and total protein were measured to find their influence on biological activities.
Vegetables’ juice displayed varying degrees of inhibitory potentials in mitigating NADPH dependent catalytic activity of aldose reductase in goat lens, accumulation of sorbitol in human erythrocytes under different glucose concentrations; Fenton-reaction induced oxidative damage to deoxyribose sugar, and calf thymus DNA. Substantial variations in vegetables phytochemicals content were also noticed in this study.
Vegetables’ juice possesses potent activities in influencing polyol pathway by various mechanisms in favour of reducing development of oxidative stress independent of their inherent antioxidative properties. Juice of ivy gourd followed by green cucumber and ridge gourd were among the most potent for they displayed strong activities on various parameters analysed in this study. These vegetables’ juice may become part of mechanism-based complementary antioxidant therapy to prevent development of diabetic complications.
Aldose reductase; antioxidant activity; diabetic complications; hyperglycemia; oxidative stress; polyol pathway; sorbitol; vegetables’ juice
Dyke-Davidoff-Masson Syndrome (DDMS) is a syndrome associated with refractory epilepsy. DDMS is a rare syndrome characterized by seizures, facial asymmetry, contralateral hemiplegia and mental retardation. The characteristic radiologic features are cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses. The case was an 18 years old female with seizures, hemiparesis of the right side and mental retardation who was diagnosed with DDMS based on computed tomography.
Dyke Davidoff Masson Syndrome; Refractory epilepsy; cerebral hemiatrophy
Transistors constitute the backbone of modern day electronics. Since their advent, researchers have been seeking ways to make smaller and more efficient transistors. Here, we demonstrate a sustained amplification of magnetic vortex core gyration in coupled two and three vortices by controlling their relative core polarities. This amplification is mediated by a cascade of antivortex solitons travelling through the dynamic stray field. We further demonstrated that the amplification can be controlled by switching the polarity of the middle vortex in a three vortex sequence and the gain can be controlled by the input signal amplitude. An attempt to show fan–out operation yielded gain for one of the symmetrically placed branches which can be reversed by switching the core polarity of all the vortices in the network. The above observations promote the magnetic vortices as suitable candidates to work as stable bipolar junction transistors (BJT).
The fatty acid desaturase (FADS) gene family at 11q12-13.1 includes FADS1 and FADS2, both known to mediate biosynthesis of omega-3 and omega-6 long-chain polyunsaturated fatty acids (LCPUFA). FADS3 is a putative desaturase due to its sequence similarity with FADS1 and FADS2, but its function is unknown. We have previously described 7 FADS3 alternative transcripts (AT) and 1 FADS2 AT conserved across multiple species. This study examined the effect of dietary LCPUFA levels on liver FADS gene expression in vivo and in vitro, evaluated by qRT-PCR. Fourteen baboon neonates were randomized to three diet groups for their first 12 weeks of life: C: Control, no LCPUFA; L: 0.33% docosahexaenoic acid (DHA)/ 0.67% arachidonic acid (ARA) (w/w); and L3: 1.00% DHA/ 0.67% ARA (w/w). Liver FADS1 and both FADS2 transcripts were downregulated by at least 50% in the L3 group compared to controls. In contrast, FADS3 AT were upregulated (L3>C), with four transcripts significantly upregulated by 40% or more. However, there was no evidence for a shift in liver fatty acids to coincide with increased FADS3 expression. Significant upregulation of FADS3 AT was also observed in human liver-derived HepG2 cells after DHA or ARA treatment. The PPARγ antagonist GW9662 prevented FADS3 upregulation, while downregulation of FADS1 and FADS2 was unaffected. Thus, FADS3 AT were directly upregulated by LCPUFA by a PPARγ-dependent mechanism unrelated to regulation of other desaturases. This opposing pattern and mechanism of regulation suggests a dissimilar function for FADS3 AT compared to other FADS gene products.
docosahexaenoic acid; arachidonic acid; polyunsaturated fatty acids; fatty acid desaturase; FADS3; alternative splicing
Stem cells present an important tool in livestock assisted reproduction and veterinary therapeutic field such as tissue engineering. We report for the first time isolation of pluripotent stem cell-like cells expressing pluripotency markers (alkaline phospahatase, OCT-4, NANOG and SOX-2) from the amnion of water buffalo (Bubalus bubalis). The cells showed no apparent abnormalities in their chromosomal profiles before and after cryopreservation. The cytochemical staining revealed that pluripotent cells were capable of undergoing directed differentiation in vitro into osteocytes. It could be inferred that amnion-derived pluripotent stem cell-like cells can be isolated, cultured for many passages and differentiated into mesoderm lineage, and may be an alternative source to mesenchymal stem cells. These cells can have applications in assisted reproduction, developmental biological and regenerative medicine.
Amnion cells; Buffalo; Differentiation; Pluripotency; Stem cells
Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiographic entity of heterogeneous etiologies that are grouped together because of similar findings on neuro-imaging and associated symptom complex of headache, vision loss, altered mentation, and seizures. Although usually considered benign and reversible, characteristics of this syndrome in pediatric patients remain obscure. This case series included 11 patients (8 males, 3 females, age 3-15 years) of PRES during September 2010 to February 2012 out of a total 660 renal pediatric patients (1.66%). We studied their clinical profile, contributory factors, and outcome. Presenting symptoms were headache in 73%, dimness of vision or cortical blindness in 36%, seizures in 91%, and altered mentation in 55%. The associated renal diseases were acute renal failure (55%), chronic renal failure (9%), and 36% had normal renal function. The contributory factors were uncontrolled hypertension (100%), severe hypoproteinemia (9%), persistent hypocalcemia (9%), hemolytic uremic syndrome (36%), cyclosporine toxicity (9%), lupus nephritis (9%), high hematocrit (9%), and pulse methylprednisolone (9%). Brain imaging showed involvement of occipito-parietal area (100%) and other brain areas (63%). All but one patient of hemolytic uremic syndrome had complete clinical neurological recovery in a week, and all had normal neurological imaging after 4-5 weeks. PRES is an underdiagnosed entity in pediatric renal disease patients. Associated hypertension, renal disease, and immunosuppressive treatment are important triggers. Early diagnosis and treatment of comorbid conditions is of prime importance for early reversal of syndrome.
Contributory factors; course and time frame of recovery; pediatric renal patients; posterior reversible encephalopathy syndrome; radio-imaging