Background- Oral leukoplakia is a very common premalignant condition that characterizes variable clinical manifestations with a significant potential for malignant transformation. In its diagnosis and treatment, diverse approaches are given such as surgical, pharmacological, and adjunctive treatments. To date, little consensus exists regarding the most appropriate diagnostic and therapeutic strategies. It is in this context that the systematic review of available evidence is needed. Methods- This systematic review will be undertaken based on the PECOS framework for defining the inclusion criteria. Selection of studies Studies evaluating diagnostic or therapeutic interventions for oral leukoplakia were selected, including randomized controlled trials, cohort studies, and observational studies. The search was performed cross five databases: PubMed, Scopus, Web of Science, Embase, and Cochrane Library, with the use of Boolean operators and MeSH keywords. An extraction table is used to summarize the study characteristics, methods of diagnosis, intervention utilized, outcomes, and statistical findings. Bias was evaluated with the ROBINS-I for non-randomised studies and the Cochrane RoB 2.0 tool for randomized trials. Results- Eight studies fulfilled the inclusion criteria. The number of sample participants varied between 18 and 4886 subjects. Routine biopsies were crucial for monitoring of the dysplastic lesions. Cancer progression risks were highly increased in biopsied groups: SIR = 40.8, 95% CI: 34.8–47.6; HR = 2.38, 95% CI: 1.73–3.28. Therapeutic treatments like curcumin resulted in increased clinical response rates (67.5% vs 55.3%, p=0.03) and AFL-PDT showed a response rate of 87.5%, but recurrence was site-specific with a relative risk of OR: 1.64 (p<0.001). Beta-carotene and Vitamin C showed minimal benefit, where remission rates in treated groups were 21.1% compared with 4.8% controls (p=0.172). Diagnostic and treatment practice deviated significantly as 83% of doctors made it a regular procedure to take biopsies (p<0.001). Pain relief was achieved through laser-assisted interventions, which significantly alleviated symptoms (p<0.05). Conclusion- The review noted heterogeneity in both diagnosis and treatment of oral leukoplakia. Even the promising results seen with treatments such as curcumin or AFL-PDT, few chemopreventive agents showed a weak efficacy level; hence, there is a need for stronger evidence. Routine biopsies were performed for risk stratification, and important geographic variability in practice was recorded. These findings underscore the need for standardized guidelines to improve the outcomes in patients.

Introduction The deficit of vitamin B12 has covered almost all interest in this micronutrient in the medical practice even if high plasma levels of B12 are not so rare and, in the majority of cases, are associated with a severe disease. Developments in the identification of the complex transport of vitamin B12 inside the human body and the standardization of the laboratory techniques for the different plasma fractions of vitamin B12 determination have been accomplished quite recently and allow a better understanding of results in different clinical conditions. If only the classical measurement of the total vitaminemia was used, a paradox between clinical manifestations of deficit and the high plasma level of cobalamin was difficult to interpret. ReviewBased on the current knowledge about the vitamin B12, in this review, we propose a physiopathological approach and classification of an elevated serum cyanocobalamin into two main categories: the disproportionate hypercobalaminemia, in which a high total level of B12 with normal or low level of holotranscobalamin is found, and the proportionate hypervitaminemia or hypercobalaminemia with hyperholotranscobalaminemia. The clinical utility of these two entities and the different tests used for the vitamin B12 metabolism characterization are interpreted for the most frequent clinical situations of an elevated B12. Conclusion Even if much progress has been made in the elucidation of vitamin B12 absorption, transport and biological role, there are many questions to be answered that will complete our attempt for systematization of the approach of a patient with hypercobalaminemia.

Introduction Acute encephalitis syndrome (AES) encompasses infections of the central nervous system generated by viruses, bacteria, fungi or parasites. Regardless of the similar clinical features produced by all agents, emerging viruses causing AES can be more devastating due to irreversible brain damage. Case report We present two cases of acute encephalitis syndrome caused by Japanese encephalitis virus from a usually under-reported geographic region of India. Both patients were managed conservatively with fatal outcome in one of them. Discussion Considerable effort should be made to identify the specific causative agent causing AES keeping in mind the varied clinical manifestations of Japanese encephalitis virus. Although the impact on management is not significant, possible transmission to healthy contacts and the community can be prevented. Conclusion Prompt identification and reporting of cases are important in order to detect and contain possible outbreaks.

Introduction The significance of the neutrophil to lymphocyte ratio (NLR) as inflammatory marker has been evaluated in a large number of diseases. Chronic silicosis is a pulmonary disease determined by the small particles of silica deposited in the distal airways and the subsequent inflammatory process. Higher values of NLR have been reported in patients with silicosis compared to the subjects exposed to silica but who are disease-free. MethodsWe conducted a retrospective study of the registered cases of silicosis from the Department of Occupational Medicine, Colentina Hospital, Bucharest, Romania. Current smokers, patients with industrial bronchitis, with pseudo-tumoral forms of silicosis or with any other chronic pulmonary disease were excluded. In total, 32 patients, 20 women and 12 men, were included in the analysis. Current data and data from 5 years before were recorded: demographics, initial diagnosis and silicosis stage, comorbidities, smoking habit, lung function, exposure and retention time and NLR. According to the differences registered in the radiological classification of silicosis, the patients were divided into two groups: group 1 included patients who presented with a more advanced stage of silicosis after 5 years of evolution and group 2 included those with no detectable signs of progression (apparently stable disease). ResultsThe comparison of the two groups showed no significant differences in terms of age, gender distribution or associated diseases, exposure or retention time. The average and median values of NLR were significantly higher in group 1 compared to group 2 (p=0.016). Conclusion Even if the number of cases is not large enough for a final conclusion, our results support the hypothesis that NLR might represent a predictive biomarker for silicosis progression.

Introduction Candidemia is the major cause of sepsis among invasive fungal infections, especially in intensive care units. Knowing hospital epidemiology and Candida resistance pattern will help in choosing empiric antifungal therapy in patients suspected with candidemia. MethodsA cross-sectional analysis of 306 Candida isolates recovered from blood culture of patients admitted to a tertiary care hospital in Chennai, South India, between May 2010 and December 2015 was carried out. Results Out of the 306 isolates, 258 (84.3%) were Candidanon-albicans and 48 (15.7%) were C. albicans. The most common species was C. tropicalis 103 (33.7%), followed by C. albicans 48 (15.7%), C. parapsilosis sensu lato 42 (13.7%), C. haemulonii sensu lato (complex) 38 (12.4%) and C. glabrata 36 (11.8%). Two hundred and thirty seven out of 306 Candidaisolates (77.5%) were susceptible to fluconazole. All C. albicansisolates (100%) and most of C. tropicalis (98%), C. parapsilosis sensu lato (95.2%), C. famata(87.5%) and C. guillermondii (83.3%) isolates were susceptible to fluconazole but only 72.3% of C. glabrata isolates and 16.7% of C. krusei isolates were fluconazole susceptible. All C. haemulonii complex isolates recovered in this study were resistant to fluconazole and all except one (37 out of 38 isolates) were resistant to amphotericin B, all were susceptible to caspofungin and voriconazole. Conclusion C. tropicalis is the most common species in our study sample and the majority of isolates remain susceptible to fluconazole, however, C. haemulonii complex has emerged as an important fluconazole resistant pathogen with uncertain therapeutic implications.

Despite the World Health Organization (WHO)’s ambitious goal of eliminating measles from the European Region by 2015, several countries in Europe have been experiencing recent outbreaks of measles, as reported by the European Center for Diseases Prevention and Control (ECDC), including Greece, Ireland (Dublin), Romania and Slovakia.