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ALS patients and caregivers would benefit from structured care plan that is sensitive to the impact of the illness on the specific domains of quality of life as well as the deterioration in the neurological functioning.

Gingival enlargements are frequently encountered in dental practice. There are different types of gingival enlargements and they vary according to the etiologic factors and pathologic processes that produce them. The exact diagnosis of the enlargement is important as some gingival enlargements can cause extensive morbidity or even mortality. Oral cancers especially squamous cell carcinomas present with variations in clinical presentation and the sites affected. A detailed medical history, clinical examination and radiographic evaluation will help identify the lesion. A biopsy will help provide a definitive diagnosis. An early diagnosis and treatment of squamous cell carcinomas is important as these tumours have a propensity for invasion of adjacent tissues and distant lymphatic metastasis which leads to a worsened prognosis. In this case report, the diagnosis and management of squamous cell carcinoma masquerading as a gingival overgrowth in the mandibular anterior region in a renal patient is reported. Dentists need to be aware and alert of the possibility of squamous cell carcinoma presenting on sites such as gingiva thereby preventing extensive morbidity and even mortality in these patients.

Introduction: Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion with varied clinical and histological presentation. It has slow growth potential and a low recurrence rate. The tumor is mainly seen in females in the second decade of life, predominantly affecting the maxilla and associated most often with unerupted canine teeth, earning the epithet "two-thirds tumor". There are three variants: intrafollicular, extrafollicular, and peripheral. The peripheral or extra osseous type is a rare form that arises in gingival tissue. Case Presentation: This article describes a case of AOT in a 10-year-old girl who presented with gingival enlargement in relation to the maxillary left central incisor. Interestingly, intraoral periapical radiography did not show any significant findings. However, cone-beam computed tomography of the site revealed significant bone loss in the area. A surgical excision was done. Histopathological examination revealed features of AOT. Based on clinical, radiographic, and histological evidence, a diagnosis of peripheral AOT (PAOT) was made. Conclusion: PAOT is a rare disease entity in children that mimics gingival swelling, and may often be misdiagnosed by dentists. With literature still ambiguous on the origin of the tumor and biological course, it becomes imperative to examine any gingival swelling in children with a proper clinical examination, periapical radiography, and if necessary conebeam computed tomography. Excision and histopathological evaluation will help in confirming the exact disease condition.

BACKGROUND AND PURPOSE: Duchenne muscular dystrophy is an X-linked disorder characterized by progressive muscle weakness and prominent nonmotor manifestations, such as a low intelligence quotient and neuropsychiatric disturbance. We investigated WM integrity in patients with Duchenne muscular dystrophy using DTI. MATERIALS AND METHODS:Fractional anisotropy and mean, axial, and radial diffusivity (DTI measures) were used to assess WM microstructural integrity along with neuropsychological evaluation in patients with Duchenne muscular dystrophy (n ¼ 60) and controls (n ¼ 40). Exon deletions in the DMD gene were confirmed using multiplex ligation-dependent probe amplification. Patients were classified into proximal (DMD Dp1401) and distal (DMD Dp140-) subgroups based on the location of the exon deletion and expression of short dystrophin Dp140 isoform. WM integrity was examined using whole-brain Tract-Based Spatial Statistics and atlas-based analysis of DTI data. The Pearson correlation was performed to investigate the possible relationship between neuropsychological scores and DTI metrics. RESULTS:The mean ages of Duchenne muscular dystrophy and control participants were 8.0 6 1.2 years and 8.2 6 1.4 years, respectively. The mean age at disease onset was 4.1 6 1.8 years, and mean illness duration was 40.8 6 25.2 months. Significant differences in neuropsychological scores were observed between the proximal and distal gene-deletion subgroups, with more severe impairment in the distal-deletion subgroup (P , .05). Localized fractional anisotropy changes were seen in the corpus callosum, parietal WM, and fornices in the patient subgroup with Dp1401, while widespread changes were noted in the Dp140-subgroup. The Dp1401 subgroup showed increased axial diffusivity in multiple WM regions relative to the Dp140-subgroup. No significant correlation was observed between clinical and neuropsychological scores and diffusion metrics.CONCLUSIONS: Widespread WM differences are evident in patients with Duchenne muscular dystrophy relative to healthy controls. Distal mutations in particular are associated with extensive WM abnormalities and poor neuropsychological profiles.