Aim: To describe a pediatric patient with an uncommon parotid region mass that was felt on ultrasound and clinical examination to be intraparotid. Case Presentation: A16-year-old female presented with a viral illness and tender left infra-auricular mass, thought to be a reactive lymph node. There was no history of trauma. The mass gradually increased in size. Physical examination revealed a 2 cm mass thought to be arising from the parotid gland. Ultrasound described a mass suspicious for an intraparotid malignancy with biopsy recommended. MRI revealed the mass to be superficial to the left parotid gland. FNA was not performed prior to surgery. Superficial parotidectomy was performed revealing a benign spindle cell tumor. Immunoperoxidase studies were performed on the specimen. The immunophenotype supports the final diagnosis of nodular fasciitis. Discussion and Conclusion: The differential diagnosis for pediatric parotid region masses is broad and includes both benign and malignant etiologies, many of which have nonspecific imaging findings. These may include schwannoma, reactive lymph node, lymphoma, pleomorphic adenoma, adenoid cystic, acinic cell and adenocarcinoma and sarcoma. Among benign masses to be considered, nodular fasciitis should be included in the differential diagnosis, especially in the context of a new rapidly growing mass and history of recent trauma. In these particular circumstances, FNA can be considered prior to biopsy or excision, sparing the potential morbidity that may be associated with invasive procedures. If FNA yields a definitive diagnosis, nodular fasciitis typically has a benign self-limited course and may completely resolve over time obviating the need for major intervention.
Aim: To compare the amount of bone loss (if any) at the mesial and distal sides in delayed and immediate loaded dental implants. Study Design: Total 20 partially edentulous (anterior region of Maxilla) patients were randomized and equally divided into two groups. Group A received delayed loaded dental implants and group B received immediate loaded dental implants. Both the groups were monitored clinically and radiographically at 3, 6, 12 and 18 months. Methodology: We included 20 patients (11 men, 09 women; age range 20-48 years) with single or multiple edentulous areas in mouth. Clinical as well as all routine hematological examinations were done. Radiographs were taken sequentially as required for 18 months. Results: There was no significant statistical difference of bone loss mesially in both the groups at 3 (P=0.99) & 6 (P=0.25) months, but there was significant statistical difference of bone loss mesially seen in both the groups at 12 (P=0.03) & 18 (P=0.01) months. There was no significant statistical difference of distal bone loss in both the groups at 3 (P=0.22), 6 (P=0.38) and 12 (P=0.17) months, but there were significant statistical difference of distal bone loss seen in both the groups at 18 months (P=0.03). The bone loss was found more with the immediate loading type of implants at both mesial and distal sides of implant. Conclusion: The immediate loading implants may provide a lot of benefits over conventional delayed loading implants but the bone loss at Crestal (Marginal) level is higher as compared to delayed loading implants when seen in maxillary anterior impants which should be considered whenever selecting any particular method of dental implantation.
Aim: Slow growth rate in culture renders the traditional isolation, identification, and drug susceptibility testing of clinically important mycobacteria inadequate when there is an urgent need for a precise diagnosis in order to initiate patient treatment. Molecular methods all rely on mycobacterial DNA isolation which in turn has become an essential step of the process. Our study aimed to evaluate DNA isolation protocols from mycobacteria of clinical interest. Methods: Therefore, in order to determine an optimal method we evaluated 8 inexpensive, rapid and easy DNA isolation methods from 30 mycobacterial cultures (10 Mycobacterium tuberculosis and 20 Non-tuberculous Mycobacteria) for subsequent direct detection by PCR. Results: Six of those 8 methods reliably allow the isolation of good DNA yields and quality, the optimal protocol being the one that includes a 1% Triton X-100 lysis solution. Protocols using SDS 1% as a lysis solution did not yield DNA suitable for PCR amplification. Conclusion: Six of the methods we evaluated can easily be implemented in resource limited settings for routine use, potentially contributing to a better management of mycobacterial infections.
Background: Syphilis is a sexually transmitted infection caused by Treponema pallidum. The disease becomes very common among individuals with multiple sexual partners without protection. Aim: This research aimed at assessing the prevalence of syphilis infection in Cape Coast Metropolis and the factors associated with the transmission of the disease Methodology: 200 participants from Cape Coast were sampled and assessed for syphilis infection using Venereal Disease Research Laboratory syphilis test strips (a nontreponemal test) and positive samples were confirmed with Treponema palladium haemagglutination (TPHA) test. Questionnaires, reflecting the participant’s sociodemographic data were also administered. The results were analysed, to assess the relationship between various risk factors and syphilis infection. Results: The prevalence of syphilis infection in Cape Coast was found to be 8.5%, mainly associated with participants having multiple sexual partners and having unprotected and indiscriminate sex. Other factors found to be indirectly affecting the rate of infection were illiteracy, lack of knowledge and information concerning the disease. Conclusion: The seroprevalence of syphilis infection in the Cape Coast Metropolis is an indication that the disease is endemic.
Studies on COPD have largely focused on the smoking rather than the non-smoking population. Hence we conducted the study to identify the non-smoking causes of COPD. The study was conducted in the Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, AMU, Aligarh during 2011-2013 on 450 COPD patients. The aim of the study was to find out proportion of non smokers among all COPD patients, identify risk factors for COPD among non smokers and classify non-smoking COPD patients according to severity. Maximum patients (35.41%) among non smoker COPD group had more than one risk factor for COPD. Most of the patients among non smoker COPD were found to be having severe to very severe disease (63.5%). 34.4% patients had moderate COPD and very few patients had mild COPD (3%). On comparing disease severity among non smoker and smoker COPD patients, we found that proportion of patients with very severe disease was more in smoker group (39.2% in smoker vs. 29.2% in non smoker), while proportion of patients with mild to moderate disease were more in non smoker group (35.5% in non smoker vs. 24% in smoker). Patients with severe disease in both groups were found to be of equal proportion (33.3% in non smoker vs. 36.7% in smoker).
Background: Accurate assessment of the severity of stenosis is critical in patients with aortic stenosis. The ambiguities and imprecisions of the current diagnostic parameters can result in sub-optimal clinical decisions. In this feasibility study, we investigate the functional diagnostic parameter AVC (Aortic Valve coefficient: ratio of the total transvalvular pressure drop to the proximal dynamic pressure) in the non-invasive assessment of the severity of aortic stenosis by correlating with the current diagnostic parameters. Methods and Results: AVC was calculated using Doppler measured diagnostic parameters obtained from retrospective chart reviews. A theoretical pressure recovery correction was applied to the pressure drop calculated from Doppler measurements to obtain AVC. A statistically significant and strong combined linear correlation (r = 0.93, p<0.001) of AVC with the transvalvular pressure drop and the left ventricular outflow tract velocity was observed. The mean values of AVC were shown to better delineate moderate and severe stenosis (54% difference) than the mean values of Doppler measured pressure drop and aortic valve area (22% and 25% difference, respectively), when the patients were categorized based on the catheterization measured pressure drop. Conclusion: The feasibility of using pressure and flow measurements obtained from Doppler measurements in a single combined diagnostic index for the assessment of aortic stenosis severity has been evaluated. The nondimensional clinical parameter, AVC, is expected to account for the variation in flow and pressure drop and thus improve the delineation of different grades of aortic stenosis. AVC must be further evaluated in a controlled prospective study.
Aims: Aim of study was to determine the perception of rural medical practice among final year medical students in medical schools of southeast Nigeria and the associated factors. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The six medical schools in southeast Nigeria, between March and May 2014. Methodology: All the final year medical students in southeast Nigeria were recruited and were eligible for voluntary participation in the study. The students were interviewed using a pretested, self-administered questionnaire. Data analysis was done using STATA statistical software; version 13 and level of significance was determined at a p value of less than 0.05. Results: Four hundred and fifty seven medical students participated in the study representing a response rate of 86.7%. The mean age of the students was 25.5±2.9 years and majority (57.1%) were male. A minor proportion of the students (13.6%) were willing to practice in the rural area after graduation. Majority of the students (80.1%) were of the opinion that doctors working in rural area should earn more than their urban counterparts. Factors associated with willingness to practice in rural area included family residence in an urban area (AOR= 0.4, 95% CI: 0.2 – 0.9); work experience before admission into medical school (AOR= 2.0, 95% CI: 1.1- 3.9); intention to specialize in Community Medicine (AOR= 3.1 95% CI: 1.2- 7.7) and satisfaction with rural community posting, (AOR=2.1, 95% CI: 1.2- 3.9). Conclusion: Majority of the students were unwilling to work in rural area after graduation. Knowing the need for doctors in rural practice, a re-orientation of the students on rural practice through adequate community exposure during rural posting is essential. There is also need for increased allowances for doctors working in rural areas and opportunities for training and or further studies should be encouraged.
Interest to develop new anticancer drugs and to design combination treatments with little or no secondary effects provides new scope for traditional phytochemicals in chemoprevention and therapy. Propolis is a known source of polyphenols, and flavonoids found in them have been widely studied as biochemical markers for botanical origin and in explaining their antioxidant capacity as a key factor in chemoprevention. Antimicrobial, anti-inflammatory and anticancer biological activities of propolis are known. Studies of cancer cells to measure the anticancer effect of propolis are designed with one carefully chosen component, and with extracts applied to cells in culture media. The antitumor effect of propolis and caffeic acid phenethyl ester (CAPE), bioactive compound of propolis extract, is seen to be associated with its ability to initiate apoptosis of cancer cells. Chrysin is a flavonoid of interest to identify signaling molecules related to cancer. As cancer cells develop multidrug resistance (MDR) during chemotherapy, this opens a new avenue of research on cellular mechanisms of propolis components in combined treatments designed to overcome MDR.
The prevalence of obesity, with its associated co-morbidities, is on the rise, and bariatric surgery is proving to be an effective means of allowing sustained weight loss as compared to alternative strategies. Follow up data is starting to accumulate showing evidence of the impact on bone metabolism, with associated clinical implications, including pathological fracture at a relatively young age. Furthermore this effect is seen to be different with regards to what type of procedure is performed. This review provides a summary on this topic, including an overview of the background science of bone metabolism and relates this to the nutritional sequelae of bariatric surgery. Follow up data on each procedure is reviewed, and recommended management and monitoring strategies discussed.
One of the major causes of death in the world is cancer. Due to significant advances in molecular and cellular biology, previous approaches in cancer treatment have progressed, applying new strategies. Identification and use of chemotherapy and radiation sensitizers and their effect on the further destruction of the cancer cells have received a lot of attention in medical studies. The main objectives of this Review Article are to identify the inhibitors of the enzyme COX -2 and mechanisms that are known to inhibit the enzyme in order to increase the sensitivity of tumour cells to radiation. COX-2 enzyme inhibition with Celecoxib and the prevention of the restoration of this tumour have been a major challenge for researchers. Evidence Acquisition: The mechanism by which the cells are radio sensitized can increase the initial damage, inhibiting the restoration and redistribution of the cell cycle as well as blocking in the more radio sensitized zone. Enhanced response to treatment would be initiated by identifying enzymes that are involved in increasing tumour growth and followed by inhibiting tumour growth and restoration. COX-2 is one of the enzymes expressed highly in tumour growth. Inhibiting this enzyme will enhance the response rate of treatment followed by the death of tumour cells. High expression of COX-2 gene in tumours is more related to tumour aggressive behaviour and a worse prognosis. Results: There are five mechanisms that the COX-2 enzyme applies to develop tumours and increase the malignant phenotype of tumour cells: 1- Apoptosis inhibition 2- Angiogenesis increase 3- Invasion rise 4- Inflammation modulation/weakened immunity, suppression 5- Procarcinogen conversion to carcinogens. Known mechanisms in increased sensitivity to radiation by Celecoxib: 1-COX-2 inhibition and subsequent reduction in PGE2 production result in increasing apoptosis and decreasing angiogenesis proliferation.2. The mechanism of COX-2 inhibition by Celecoxib has not been fully recognized. The drug inhibits the COX-2 enzyme through TNF-α signalling by nuclear transfer inhibition of growth factor. It also inhibits NF-KB transcription factor activation. Apoptosis inhibition is one of the mechanisms implemented by COX-2 that increases tumourigenesis. Cell cycle arrest at G1-S is one of the most sensitized areas to radiation. Studies in the field of pancreatic and ovarian carcinoma cells show cell cycle arrest at G1-S; the mechanism by which this arrest happens is not fully understood. Conclusions: Celecoxib, as a COX-2 inhibitor that affects and inhibits some enzymes and creates changes in the cell cycle process, has the role of a radiosensitizer. Celecoxib prevents cancer. Celecoxib inhibits tumour growth delay and the amount is insignificant. Simultaneous application of radio sensitzers such as celecoxib and chemo radiotherapy procedures will have a more damaging effect on the tumour cells.