Introduction: For successful endodontic therapy it is vital to have thorough knowledge of morphology of the root canal system and its variations besides proficient aseptic intraoperative condition. Mandibular second premolars are usually single rooted tooth with single root canal system. The incidence of the number of roots and the number of canals varies greatly in the literature. Methods and Results: This case report describes an unusual case of mandibular second premolar with two roots and five root canals. This was confirmed by radiographs, dentascan and dental operating microscope (DOM), and was successfully treated using K files system, gutta-percha and AH plus sealer in lateral condensation manner. Conclusion: The clinical significance of this case report is that the precise awareness about the aberrant morphologies of the root canal system can only be appreciated when advanced radiographic techniques, magnification and illumination are used to treat such type of cases.
Acute sinusitis secondary to virulent organisms can initially be subtle, or might be misdiagnosed as viral sinusitis. It is one of the most common diagnoses we face in clinical practice. Among all the variable etiologies, fungal sinusitis is the most obscure with devastating consequences. The purpose of this case report is to increase the awareness of health care professionals about invasive fungal sinusitis as an under-diagnosed disease, and emphasize that excellent outcome can be achieved by early employment of different therapeutic modalities. In this case report, we review an older adult male, with significant cardiac and diabetes history, who presented with acute rhino-orbital mucormycosis, and was successfully treated with prompt endoscopic surgical debridement, dual IV antifungals, local amphotericin B nasal washing, and hyperbaric oxygen therapy. All of the above led to extremely favorable outcome for such an aggressive infection.
Background: Acute kidney injury (AKI) is a frequent complication in hospitalized patients. Incidence of AKI in hospitalized patients with cancer is increasing, but there have been few studies on AKI in patients with cancer. The purposes of this study were: 1. To evaluate and compare the characteristics and outcomes of cancer and non-cancer AKI patients; 2. To determine the impact of cancer diagnosis on hospital mortality of AKI patients; and 3. To compare outcome predictors between the two groups of AKI patients. Methods: We conducted a retrospective cohort study in a South Korean tertiary care hospital. A total of 2211 consecutive patients (without cancer 61.5%; with cancer 38.5%) were included over a 140-month period. Predictors of all-cause death were examined using the Kaplan-Meier method and the Cox proportional hazards model. Results: The main contributing factors of AKI were sepsis (31.1%) and ischemia (52.7%). AKI was multifactorial in 78% of patients with cancer and in 71% of patients without cancer. Hospital mortality rates were higher in patients with cancer (42.8%) than in patients without cancer (22.5%) (P = 0.014). In multivariate analyses, diabetes mellitus (DM) and cancer diagnosis were associated with hospital mortality. Cancer diagnosis was independently associated with mortality [odds ratio = 3.010 (95% confidence interval, 2.340-3.873), P = 0.001]. Kaplan-Meier analysis revealed that subjects with DM and cancer (n = 146) had lower survival rates than subjects with DM and without cancer (n = 687) (log rank test, P = 0.001). Conclusion: The presence of DM and cancer were independently associated with mortality in AKI patients both with and without cancer. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.
Aims: Fracture of dentures is a common clinical finding in daily prosthodontic practice, resulting in great inconvenience to both the patient and the dentist. A satisfactory repair should be cost-effective, simple to perform, and quick. This study evaluated and compared the transverse strength of two heat cure denture base resins repaired with auto polymerizing resin by wetting with methyl methacrylate (MMA) at different time intervals. Materials and Methods: Stellon and Trevalon denture base materials were used in the study. A total of 200 heat cure acrylic resin specimens (100 specimens each of Stellon and Trevalon acrylic material) with the dimensions of (65 mm x 10 mm x 3 mm) were prepared. The specimens were divided with 10 specimens for each of the test groups (n =10). The test groups were designated as Group A through J. Repair gap of 2 mm was prepared in the centre of the specimen. The repair surface of the specimens were wetted with MMA at different time intervals (1, 2, 3, 4, 5, 10, 15 and 30 minutes) and repaired by using auto polymerizing resin. The transverse strength of the repaired specimens was tested by a 3 point bending test. All data was statistically analyzed with one-way ANOVA, differences within the groups were analyzed by independent sample t -test. Results: The results showed that the significant difference between the specimens wetted with MMA at different time intervals. A gradual increase was shown in the mean transverse strength of repaired specimens wetted from 1 minute to 5 minutes in Stellon and from 1 minute to 10 minutes in Trevalon. Conclusion: Wetting the repair surfaces with MMA for a period of more than 5 minutes and 10 minutes in case of Stellon and Trevalon respectively increases the incidence of adhesive failure in the repaired specimens.
Background: Previously we have described the "cavitary” type of angiogenesis by gastric cancer (GC) consisting of the formation of “cavitary structures” (CS) in tumor stroma, which are then lined by endothelial cells and merged into the blood vessels of the organ. The morphological features of the "cavitary” type of angiogenesis in intestinal and diffuse types of GC and the relations of CS with the tumor-infiltrating immune cells, was the purpose of this study. Materials and Methods: The samples of tumor and adjacent gastric mucosa (GM) in 73 patients with GC who had undergone radical surgery were being studied. The sections were stained with hematoxylin and eosin and immunohistochemically using antibodies to CD34, CD4, CD8, CD20 Ð¸ CD68. Results: The differences of “cavitary” type of angiogenesis in the intestinal and diffuse types of GC are only associated with CS type-1 that are formed as a result of the abruption of epithelial cells from the underlying stroma. In the intestinal type of GC the basis for the formation of CS type-1 are the tumor glands. The wall of such CS is most likely the basement membrane bordering the connective tissue. In the diffuse type of GC the CS type-1 are presented as the structures limited from outside by the tumor cells. In their lumen the fragments of tumor tissue having the same structure as the surrounding one are being detected. The performed analysis showed that the number of CS type-1 was associated with the density of CD68, whereas the presence of CS type-2 – with the presence of lymphoid follicles (LF) and B-cell infiltrations at the boundary of tumor and GM. The density of CD68 in GM was higher in cases with multiple CS type-1 (72.6±47.0 vs. 41.6±15.4 cells per unit area, P= .03). In turn, CS type-2 were more often met in the presence of multiple LF (72,3% vs. 33,3%, P= ,04) and B-cell infiltrations (90% vs. 26,3%, P= ,001). Conclusion: The obtained data testify about the relation of CD20 lymphocytes and CD68 macrophages with the "cavitary” type of angiogenesis.
Aims: The purpose of this study is to determine the prevalence and degree of expression of the carabelli trait in the permanent first and second maxillary molars in a selected Nepalese population residing in Madi village of Chitwan district. Study Design: Cross sectional descriptive study. Place and Duration of Study: Madi village of Chitwan district in the month of April 2014. Methodology: The study was conducted among the 300 dental patients of age 14 years and above attending a dental health camp. The palatal surfaces of the mesio-lingual cusp of the left and right maxillary first and second molars of the subjects were examined with mirror and probe for the presence or absence of the Carabelli trait. When present, the Carabelli trait was graded as I-IV, pit (I), groove (II), cusp without free tip (III), and well developed cusp (IV) according to the classification of Goose and Lee. Results: The mean age of the patients was 39.47 +/-16.33 years with male: female ratio of 1:1.01. Two hundred five (68.3%) of the cases had presence of carabelli trait on either of the first molars. Further, 75 (25.0%) had carabelli trait on either of the second molars. None of the cases had the trait only in second molars. The association of carabelli trait had no significant relation to sex (P=0.15). Bilateral presence of the carabelli trait in 16 and 26 was noticed in 151 (73.7%) of the total 205 cases. Likewise, the bilateral expression in 17/27 was seen in 53 (70.7%) of the total 75 cases. The association of the trait bilaterally was significant for both the sides (P<0.001). Conclusion: The expression of carabelli trait in the selected Nepalese population is fairly high although frank cusp was rarely noticed. The bilateral presence of the trait was common. The bilateral presence of the trait was common. The study of the presence and degree of expression of the trait is implied in the determination of ethnic origin of the individuals.
Background: An awareness of learning styles may help teachers modify their teaching methods to improve the educational outcomes of their students. Aim: The aim of this study was to determine the learning styles of medical students during their basic science training at Mashhad University Medical School (MUMS). Methods: The VARK (Visual, aural, read/write and kinesthetic learning styles) questionnaire was used to gather information on learning styles in 245 medical students during their basic science training at MUMS in 2014. The questionnaire was previously assessed for its validity and reliability. Data were analyzed using SPSS software. Results: Overall, 245 students (115 male/130 female) with a mean age of 22.172±.27 years completed the questionnaire. Of these students 91.84% preferred a single- modal learning style and 8.16% of students preferred a multi-modal learning style. Of the students with a preference for a single modal learning style, 20% (45 students) had a preference for visual, and 53.33% (100 students) for auditory learning styles respectively; 22.22% (50 students) of students were categorized as single read-write and 4.44% (10 students) were classified as having a kinesthetic learning style preference respectively. Among the multi-modal group, 25% (5 students) of students preferred a bimodal and 75% (15 students) preferred a quad-modal learning style. There was a significant association between learning styles with age and gender (P<0.05), but there was no significant association between the preferred learning styles with marital status or place of residence (P>0.05). Conclusions: The key finding of our study was that learning style is age and gender dependent. Different teaching methods may be appropriate for men and women.
Aim: To describe the determinants of primary pyomyositis in Northern Uganda. Study Design and Setting: A case-control and a cohort study designs were conducted in Hospitals in Northern Uganda. Methods: Primary pyomyositis patients were consecutively recruited and followed to discharge. Controls had minor trauma and were age and sex matched with cases. Patients were admitted, investigated (clinical features, imaging, hematology, clinical chemistry and histology from muscle biopsy); managed surgically and followed up to discharge. Those that did not meet the inclusion criteria for diagnosis histologically were excluded. Ethical approval was obtained from Gulu University IRB. Results: The determinants of primary pyomyositis were: HIV positivity with low CD4 counts (<250 cells/ml) (χ2=11.748; p<0.001; aOR 11.292 at 95% CI (0.698,182.707) (p=0.088)); clinical features of immunosuppression/AIDS (χ2=12.70; p<0.001; aOR 6.50 at 95% CI (0.000,2.500) (p=0.850)); High serum creatinine level (χ2=20.191; p<0.001; aOR 6.070 at 95% CI (0.289,127.545) (p=0.317)) and Low serum albumin (malnutrition) (χ2=103.247; p<0.001; aOR 226.004 at 95% CI (13.449, 3797.786) (p<0.001)). Conclusion: The determinant of primary pyomyositis was low serum albumin (malnutrition) while clinical features of immunosuppression/AIDS, high serum creatinine level and HIV positivity with low CD4 counts were risk factors but not independent predictors of this disease.
Aims: Down syndrome (DS) is the most common chromosome abnormality among live born infants. The aim of this study is to determine the Clinical outcome of patients with DS and congenital heart disease (CHD). Study Design: A cross-sectional study. Place and Duration of Study: On 100 patients with DS and CHD who underwent diagnostic and therapeutic work up in the pediatric cardiology department from September 2001 through September 2012 in Imam Reza hospital (Mashhad, Iran). Methodology: All data collected according to a designed checklist. Most of these patients had previous history of admission in the pediatric cardiology ward. Some of these data were derived from the patient's file. Others data got by taking a history from the parents of patients and direct follow up of the patients by pediatric assistant and echocardiography by a pediatric cardiologist. Surgery was done in Imam Reza hospital. Palliative surgeries include Pulmonary Artery Banding (PAB) +/- PDA closure (if the PDA was present) and total corrections include complete correction of the defect such as ASD closure, VSD closure and repair of other defects. Medical treatments include Digoxin, Captopril, Sildenafil and Propranolol which were administered based on the type of disorders. Independent t-test, and Chi-square test were used to compare quantitative and qualitative variables between groups, respectively. Data analysis was done with SPSS ver. 11.5 and P<0.05 was considered as statistically significant. Results: The mean age of CHD diagnosis was 3.10±2.52 months and mean age of refer to pediatric cardiologist was 5.46±8.60 months. 52% of subjects were females. 50 patients underwent surgical therapy and 50 patients underwent non-surgical therapy (Medical therapy). Of 100 patients, 43(43%) patients were expired, 36(36%) patients had improved signs, and complications were detected in 25(43.85%) of live patients. The mean age of death in patients was 15.24±11.69 months. The Pulmonary Arterial Pressure (PAP (decreased in 68.4 percent of patients after surgical therapy and 16.6 percent of patients with non-surgical therapy. There is a significant correlation between the type of therapy and PAP after treatment (P=.001). Complications of CHD were detected in 8 patients of the surgical group (27.58% of live patients), 5(33.33%) patients of non-surgical (Medical therapy) group and in 12(92.3%) the refusing surgery group. Conclusion: The early diagnosis and therapeutic intervention especially cardiac surgery is critical in this group.
Background: The increasing incidence of high blood pressure, its complications and associated fatalities has led to an upsurge in the use of alternate forms of medicaments in its management. The oral ingestion of the hemolymph of Archachatina marginata is commonly used as an antihypertensive by the Yoruba people of South West Nigeria. This study investigated the effect of oral administration of Archachatina hemolymph on normotensive and adrenaline induced hypertensive wistar rats. Methods: The hemolymph of Archachatina marginata was orally administered at doses of 22.8 and 45.6 mg/kg body weight to normotensive and adrenaline induced hypertensive rats for 7 days. Blood pressure parameters were measured via a polygraph. Histopathological assessment of the heart tissue was conducted. Data gathering and analysis were done in 2014 (February – August). Results: In this study, the orally administered hemolymph had no significant (pË‚0.05) lowering effect on the systolic/ diastolic pressure, pulse pressure, mean arterial pressure or heart rate of either the normotensive or adrenaline induced hypertensive rats. Histopathological assessment of the cross section of the heart tissues shows the hemolymph had no adverse effect on the examined cross section of the heart tissue. Conclusion: Based on the data from this study, there is no justifiable reason for the use of the hemolymph of Archachatina marginata as a antihypertensive.