The possibility of a three rooted maxillary second premolar is extremely rare; diagnosis and treatment of such cases is challenging especially for undergraduate dental students. The aim of this report is to present a root canal treatment of a very rare case of a three rooted upper maxillary second premolar tooth done by an undergraduate dental student. The tooth was diagnosed as acute irreversible pulpitis. Visually the tooth morphologically looked as a normal premolar but radiographically revealed anatomical variations of three roots. Access cavity was opened carefully; three canals were detected, negotiated, biomechanically prepared and obturated by cold gutta percha lateral condensation technique. The tooth is now completely asymptomatic for almost five months and will be both clinically and radiographicaly monitored bimonthly. A correct radiographic and clinical examination based on knowledge of anatomical variation of this tooth is necessary for successful treatment and better prognosis. Under direct supervision, undergraduate clinical students can perform root canal treatment of difficult cases.
Management of permanent tooth avulsion often challenging for dental practitioner, as avulsion resulting complete exfoliation of tooth from its socket, is usually associated with damage to the supporting structures. Managing the edentulous area to improve aesthetics, phonetics, function is better achieved by replanting the avulsed tooth rather than prosthesis. This article report a case avulsed tooth management of 12-year-old-girl due to accidental knocked out of both central incisors. Immediate after injuries patient report to the emergency department over phone and asked to collect and keep the avulsed tooth sinking into milk. Patient was managed by dentist within 60 minutes of the accident and have follow-up by radiologically and clinically 1 year post accident. Replantation of tooth immediate after avulsion can be managed by replantation into its socket.
A healthy 48 year-old man became unconscious suddenly, with a corporal temperature of 43ºC when participating in a strenuous motorcycle off-road competition in the last 2 days in southeastern Brazil on a very hot and humid summer. Once the first 6 hours of in-hospital he had dysfunction of several organ and systems. During the following days, he developed fulminant hepatic failure (FHF), disseminated intravascular coagulation, rhabdomyolysis and multiple organ failure. Despite the use of immediate conventional core body temperature control methods and support of organ-system function, the patient died on 11th day. Autopsy findings: there was significant jaundice impregnation, petechial and hemorrhagic suffusions in the skin and in visceral organs as well as generalized edema. The microscopic exam showed cytotoxic and vasogenic brain edema and encephalic death. The liver and the pancreas were diffusely necrotic and hemorrhagic, besides rhabdomyolysis, cardiac failure and acute tubular necrosis in the kidneys. The immunohistochemistry exam showed diffuse liberation in the lung and other viscera tissue of tumor necrosis factor-α (TNFα). In spite of being a rare occurrence, FHF should be included in the complications induced by exertion and commonly progresses to death.
The cause of B-cell Acute Lymphoblastic Leukemia (B-ALL) is unknown. Some studies suggested that the cause might be a deficiency in certain transcription factors due to a genetic deletion. We would like to propose a different event that might cause such deficiency. This event is the presence of certain latent viruses in infected cells. The event and its molecular, cellular and clinical consequences have been described by Hanan Polansky in 2003 in his book on Microcompetition.
Aims: The transition from school to university, traineeship or job especially along with moving away from home may lead to unhealthy lifestyle changes in young adults. Thus, we determined the effect of exercise changes during the college years on the development of cardiometabolic risk. Two cohorts of students with considerably varying demands on physical fitness (sport versus dentistry students) were compared. Methodology: 53 randomly selected German male and female sport students (SPS, 20±2 yrs.) and 61 male and female dental students (DES, 21±2 yrs.) were accompanied over their ≈5 years of college. Changes of physical activity and exercise were assessed by dedicated questionnaires and interviews. Metabolic syndrome (MetS)-Z-Score based on the NCEP ATP III definition of the MetS, abdominal fat (%) as assessed by Dual Energy X-Ray Absorptiometry (DXA) and cardiorespiratory fitness (CRF) as assessed by stepwise bicycle ergometry determined the cardiometabolic risk at baseline and 5 year follow-up. Results: 67 percent of the subjects initially included completed the follow-up-assessments. During the 5-year study period physical activity non-significantly increased in both groups (5-10%, P>.15). Indices of exercise increased significantly in the SPS group (P<.001) and decreased significantly (P<.001) in the DES group. Group differences were significant (P≤.047) for all study endpoints with more favorable changes among the SPS group for MetS-Z-Score (-0.25±0.56, P=.367 vs. DES: 1.44±0.78, P<.001), abdominal body fat (1.9±12.8%, P=.539 vs. 10.9±21.8%, P=.004) and CRF (1.6±2.9%, P=.076 vs. -3.3±4.1%, P=.004). Conclusion: Reductions of exercise volume and particularly exercise intensity caused by occupational factors during the college years may be the most prominent risk factor for cardiometabolic diseases in young adults. Compensatory exercise is thus highly relevant and may offset an otherwise unhealthy lifestyle.
Introduction: Extra pulmonary form of tuberculosis is an important public health disease which cannot be ignored because of its low transmissibility. Data on the exact burden of the disease in developing countries is scarce. Aim: To assess the burden of the disease in a tertiary care hospital of India. To study the clinical trends in the disease, and the utility of various diagnostic modalities for its diagnosis. To identify the Mycobacterial species and perform drug susceptibility test. Materials and Methods: A cross sectional study was carried out for a period of two years. A total of one hundred and forty seven samples were tested for extrapulmonary tuberculosis using a combination of bacteriological, cytological, histological and biochemical techniques to achieve proper diagnosis of the disease. Results: Young adults and females predominated in the study group and positive cases. Microbiologically, 26% of the specimens were positive. Eighteen percent of them were found to be culture positive for M. tuberculosis. Smear by Ziehl Neelsen stain was positive in 9%. A combination of culture media both solid and liquid maximized the yield of Mycobacteria. Lymph node tuberculosis was found to be the predominant type followed by others. Fifteen percent of the strains were found to be resistant to the first line drugs used in treatment of tuberculosis. Cytology and biochemical findings were found to be less specific in diagnosis of extrapulmonary tuberculosis. Conclusion: Extrapulmonary form of tuberculosis is seen in significant number of the suspects. Hence, attention should be paid towards its proper and early diagnosis followed by rational management, as if neglected may lead to associated complications and sequalae.
Background: Renal blood flow evaluation during malaria illness is rarely done despite the high incidence of kidney injury from malaria and availability of Doppler ultrasound scanners in malaria endemic areas. Aims: This study is to evaluate the renal blood flow changes using Doppler ultrasonography among uncomplicated and complicated malaria subsets of pediatric patient with laboratory evidence of malaria parasitemia and without background clinical and laboratory evidence of renal impairment. And to compare these with parameters of age matched healthy pediatric control. Study Design: This was a prospective case control study of renal Doppler indices in children with acute malaria. Place of Study: The study was conducted among pediatric patients presenting at the children outpatient clinics, emergency and pediatric wards of the University College Hospital (UCH), Ibadan Nigeria. Methodology: Doppler indices of 602 kidneys were evaluated among 85 uncomplicated (UM), 85 complicated malaria (CM) children that presented within 24 hours and follow up scans on days 3 and 5 of their illness. These were compared with that of 131 healthy children (control). Results: The main renal artery diameter of the CM group was 0.41±0.07 mm, UM=0.48±0.09 mm and 0.53±0.11 mm (p=<0.001) in the control group. The main renal vein diameter were 0.59±0.11 mm and 0.48±0.10 mm and 0.63±0.15 mm (P=<0.000) among the CM, UM and the control group respectively. The PSV and EDV were slightly lower in the malaria groups than in the control group. PSV=49.01±18.21 cm/s in the UM and CM=50.71±19.68 cm/s. The control group PSV was 56.95±15.47 cm/s. AT was however significantly lower in the two malaria subgroups than in the control. (UM=47.70±18.28 cm/s, CM=52.33±21.06 cm/s and control=75.20±27.66 cm/s respectively (p=<0.000). The Intrarenal S/D in UM was 2.73±0.49 and the CM group S/D was 3.05±0.65 and control=2.62±0.47 (P=0.04). Slightly lower but statistically insignificant mean values were seen in the RI and PI. Conclusion: The main renal arterial and vein diameters and the intra renal vessel AT are significantly reduced during acute falciparum malaria illness. The intra-renal PSV and EDV are likely to be lower in acute falciparum malaria than in the normal healthy children. The intra-renal S/D are significantly higher in the UM and CM. Also, the PI and RI are likely to be higher in the malaria groups. The AT and S/D both showed inverse and direct relationship respectively as malaria severity worsens. We propose that renal Doppler ultrasound can be used to monitor renal status and should be included in the management of children with acute malaria infection more so in malaria endemic area.
Aims: The methods of renal replacement therapy influence highly the quality of life (QOL) of patients with chronic kidney disease. The present study aimed to evaluate and compare the QOL in patients undergoing hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (KT). Methodology: The sample consisted of 186 patients attending Nicosia General Hospital in 2012, 118 HD patients, 23 PD patients and 45 KT patients. QOL was assessed by the Greek Kidney Disease Quality of Life-Short Form (KDQOL-SF 36). Results: Patients on HD had worse scores in all components. All three patient groups showed highest scores in mental health (HD: 57.7; PD: 70.3; KT: 75.6), whereas the lowest scores were observed in the component role physical (HD 33.1; PD 54.4 and KT 56.7) and general health (HD 32.5; PD 44.1 and KT 60.4). KT patients achieved highest scores in the physical component summary and mental component summary, as well as in the component summary of renal disease, followed by peritoneal dialysis patients. Male gender was significantly associated with higher score. Conclusion: The study demonstrate that among the three groups the patients on hemodialysis had the worst scores, whereas the best scores are seen in KT patients. Lower scores are reported in the physical health component and here especially in the general health. Physicians as well as nursing personnel should be aware of the effects of dialysis and could improve both physical and mental health implementing empowerment programs in departments of HD and PD, to support patients in managing their health-related conditions.
Aims: To determine normal peak bone mineral density (PBMD) values in a cohort of healthy Omanis. Study Design: Cross-sectional study. Place and Duration of the study: in the Departments of Nuclear Medicine and Medicine at Sultan Qaboos University Hospital in Oman between 2012 and 2013. Methodology: Omani employees aged between 25 to 34 years at Sultan Qaboos University Hospital (SQUH) were randomly chosen and invited to participate. Fifty normal males and 50 females were studied. Their fully informed consent was obtained to establish PBMD values using dual energy X-ray absorptiometry (DXA). Blood was also taken to determine their serum calcium, phosphate, alkaline phosphatase and parathyroid hormone (PTH) levels as well as a complete blood count (CBC), serum sodium, potassium and creatinine levels. Statistical analysis was done based on Hologic Delphi Reference Values on a reference curve generation using z-scores and the fitting a polynomial curve of third order. This data was interpolated, sampled and tested to verify the initial results. Results: Our results show that normal Omani PBMD values of L1-L4 in women were 0.94 0.11 and in men 0.99 0.12 g/cm2. These are significantly lower than those of a normal Caucasian population by 26.5% in women P-value (<.001) and by 23.8% in men P-value (<.001). Only three subjects had values on or slightly above the mean Caucasian level but sixteen had values on or below -2SD. The blood tests were within the normal range in all subjects. Conclusion: Omani mean PBMD values obtained in this study are substantially lower than Caucasian values. To avoid the use of inappropriate anti-resorptive therapy we should consider revising our reference range. We recommend using normal Asian reference values as they are almost identical to those obtained in this study until a normal reference range is established for this country.
Background: The female condom remains the only female-initiated means of preventing both pregnancy and sexually transmitted infections, including HIV. Unfortunately uptake in the West and in some developing countries has been low thus precluding the realization of the dual benefits of this device. Aim: The aim of the study was to determine the prevalence of the use of the female condom and factors associated with its use among female students in a tertiary institution of learning in Enugu, Nigeria. Methods: This was a questionnaire based non comparative study. Sampling was by multi-stage technique. Data was collected using a semi-structured self administered questionnaire. Data was analyzed using SSPS statistical software version 17.0 for windows [Chicago IL, USA]. Bivariate analysis was done to determine the association of socio-demographic variables with awareness and use of female condoms using Pearson Chi-square test. P-value <0.05 was considered significant. Results: A total of 313 female undergraduates were studied. Their mean age was 23.9 years ± 4.1 SD. About 76.7% had knowledge of female condoms. Fifty (15.9%) used the female condom since admission to tertiary institution principally to prevent unwanted pregnancy and sexually transmitted infections. Among those that used the female condom the potential dropout rate was 58%, mainly because it was costly and not readily available. The feature of female initiation and control of the device was the principal reason or intention to continue to use the female condom. The socio-demographic characteristics that were significantly associated with the use of the female condom included marital status (χ2=7.79, p=0.01), religion (χ2-5.67, p-0.02), course of study (χ2=14.26, p=0.00) and previous sexual exposure prior to university admission (χ2=3.48, p=0.00). Conclusion: There was a low use rate for the female condom despite a high level of awareness and this could be due to non-availability and cost. It is recommended that donor agencies, governmental and non-governmental organizations pool their efforts together to make female condoms more available and affordable.