Ranula is a cystic lesion arising in the oral cavity in relation to the sublingual gland. Typically ranulas are unilateral although there has been a report of superficial dissecting ranula crossing the midline thus presenting as a bilateral lesion. This article is about our experience with a similar large right sided sublingual ranula crossing the midline in a 17 year old female who underwent a complete excision of the lesion along with removal of ipsilateral sublingual gland which is the accepted treatment at present.
Aim: To estimate prevalence of TB among inmates and staff of three prisons in south India.
Place of Study: The study was undertaken in three purposively selected prisons in Karnataka State, India, namely, Belgaum, Mysore and Mangalore prisons.
Methodology: A descriptive, cross-sectional study was undertaken among a total of 2450 inmates and 280 staff at the three selected prisons. Inmates and prison staff were screened for cough of ≥ 2 weeks and the identified TB suspects were subjected to sputum microscopy for acid fast bacilli using ZN staining and fluorescent microscopy.
Results: 81 TB suspects were identified among the inmates and none among the staff. Of the 81 TB suspects, none were positive for acid fast bacilli. 10 inmates at the prisons were already on DOTS for pulmonary TB. A prevalence of pulmonary TB of 4/1000 prison inmates was estimated. Unmet need for medical care was elicited among TB suspects. Past history of anti-TB treatment and history of current smoking were identified as significant risk factors for TB in the selected prisons.
Conclusion: The estimated prevalence of pulmonary TB in the selected prisons (4/1000 prison inmates and staff) was almost twice that in the Indian general population (2.11/1000 general population).
Aim: To study (1) effect of pioglitazone mono-therapy on body composition in treatment naive type-2 diabetes mellitus patients and (2) relationship between changes in body composition and insulin resistance induced by pioglitazone.
Methods:Subjects: 49 newly diagnosed non-obese T2DM patients were recruited. Design: Open label observational study. Drug and Dose: pioglitazone 30 mg orally once daily for at least 6 months. Exclusion: Primary un-responsiveness at 3 months (10 subjects) and adverse effect (2 subjects). Final analysis done on 37 subjects (Mean age 47.9 years, male:female ratio 20:10) Controls: 37 healthy control subjects (Mean age 47 years M:F ratio 27:10) with normal glucose as per American Diabetes Association criteria. Study parameters were: Plasma glucose, Lipid profile, body mass index, HOMA-R, HOMA-B and body composition measured by dual-energy X-ray absorptiometry (DEXA) at start and after at least 6 months of follow up.
Results: Treatment with pioglitazone was associated with significantly decreased glycated hemoglobin (HbA1c), fasting and post-prandial plasma glucose, insulin resistance and triglycerides HDL ratio.Significant increase in total body, limb and head fat mass was observed. The trunk composition did not show significant change. The DEXA Parameters of body composition of diabetics became comparable with controls. Significant correlation was seen between decrease in FPG, PPG, insulin resistance and increase in limb fat mass.
Conclusions: Pioglitazone alters body composition by increasing limb and head fat content, without altering trunk fat. Decrease in insulin resistance by it is related to increase in limb fat mass.
Aims: In this study, the probable relationships between the types and factors of the Five Factor Model of Personality (FFM), which is a contemporary personality model, and the Nine Types Temperament Model (NTTM), which is a new temperament model, were investigated. Separately, the power of some of the types of NTTM to predict the dimensions of FFM was evaluated, as well.
Study Design: Cross-sectional survey.
Place and Duration of Study: Bezmialem Vakıf University (BVU) Psychiatry Outpatient Clinic (Turkey) between June 2013 and January 2014.
Methodology: The sampling of the research consists of 247 healthy volunteers. Materials of the research include the Five-Factor Personality Inventory (FFPI) and The Nine Type Temperament Scale (NTTS).
Results: All types of NTTM showed a significant correlation along with at least one of the FFPI factors at the level of 0.40 and above. Furthermore, the types of NTTM were determined to have predicted the dimensions of the FFPI by 34% and above.
Conclusion: Significant correlations were found between the types of NTTM and the FFM factors. The results are discussed in regards to how the differences in the conceptual approach can be understood and the area of use between NTTM and FFM.
Aim: To evaluate the Opportunistic Infection/Anti-Retro-Viral Therapy program at a Referral health facility in Zimbabwe.
Methods: This was a descriptive cross sectional study using the logic framework evaluation method from August 2012 to July 2013. Key informant interviews, patient records reviews and checklists were used to collect data.
Results: Over 90% of the patients got counseling when they were tested and at least 50% attended more than one counseling session before initiation of ART. The key informant reported two stocks out episodes for 2nd line salvage drugs. Patients were initiated on ART in line with 2007 ART guidelines. There was no waiting list. The staff indicated that they had been working for the OI/ART program for periods which ranged from as short as 2 days to as long as 8 years, with the majority 11(57%) having been working there for less than a year. Over 70% of the health care providers have received both protocol training and ART delivery training at the clinic and were providing counseling as required. Over 15% did not receive ART delivery training while data was not available for slightly over 10% of the care givers.
Conclusion: Wilkins Hospital is offering most services expected of a level 4 facility. Physical space and staff patient ratio fell within expected levels. However, adequate drug stocks must be maintained, a patient follow up mechanism be put in place, there is need for decentralization of stable patients to help address space inadequacy. Repairing vital equipment such as the CD4 count and the viral load machines may compromise reliability and validity of results, therefore with urgency, a continuous assessment for reliability and validity of such equipment is necessary.
Aims: Evaluating the prevalence of tooth loss, edentulism, prosthetic rehabilitation needs and the use of dental prosthesis as well as determine associations between tooth loss and age, sex, economic classification and race of the population studied.
Methodology: A cross-sectional study was conducted with 776 patients aged 15 years old or older seeking public health care at Family Health Units in the city of Recife (northeastern Brazil). Tooth loss was evaluated through an intraoral examination and categorized as 1) a maximum of 12 teeth lost or 2) more than 13 teeth lost.
Results: Prevalence rates were 85.3% for tooth loss, 5.5% for edentulism and 29% for more than 13 teeth lost. The prevalence rates for the use of maxillary and mandibular dental prostheses and the need of prosthetic rehabilitation were 35.7%, 8.9% and 85.3%, respectively. Binary logistic regression provided the following p-values: < 0.001 for age, 0.449 for sex, 0.043 for economic classification and 0.983 for race. The outcomes were not significantly associated with race or sex.
Conclusions: The prevalence of tooth loss, edentulism and the need of prosthetic rehabilitation were considered high in the population studied and were strongly associated with a low income and an older age. The prevalence of the use of dental prostheses was considered low. Sex and race exerted no influence on tooth loss.
Clinical Relevance: A better understanding of tooth loss will allow dentists to comprehend the etiological factors of this outcome, with a consequent reduction in its prevalence, thereby benefiting the population.
Background: Barrett’s esophagus (BE) is defined as a suspect endoscopic finding followed by pathologically proven specific intestinal metaplasia as opposed to the normal squamous epithelium of the esophagus. A new BE classification, the Prague C and M criteria, was proposed in 2006 to define the extent of BE based on the circumference (C) and maximum diameter (M) of the lesion.
AIM: In this study, we adopted Prague C and M criteria to record endoscopically suspected esophageal metaplasia (ESEM); biopsies were subsequently taken to determine any correlation between ESEM and histologically proven BE. The risk factors of BE were also investigated.
Methods: This was an observational study. From June 2006 to June 2009, 62 cases of ESEM were enrolled with subsequent standardized random biopsies (four pieces were taken every 2 cm from the four quarters of the esophagus). BE was defined by histological verification of specialized intestinal metaplasia (SIM). Data were analyzed to identify correlations between ESEM and BE. Logistic regression models were used to investigate the relationship between age, gender, hiatal hernia, long-segment metaplasia (LS defined as maximal extension greater than 3 cm from the SCJ), and BE. A multi-variate regression model was also used.
Results: A total of 6836 subjects who underwent endoscopic examination were enrolled from June 2006 to June 2009. Of these, 42 BE subjects were confirmed among 62 ESEM cases; the prevalence of BE among cases that received endoscopy was 0.61%. Long-segment ESEM was more prevalent than short segment (LS: SS = 43:19). Several factors such as age, gender, hiatal hernia, and LS were analyzed using a regression model; this model revealed that only LS ESEM predicted BE with borderline significance (p = 0.07). However, a multi-variate regression model including all the factors revealed that males with ESEM were significantly associated with BE (p = 0.015).
Conclusion: This study was performed in single center and used Prague C and M criteria to record ESEM. The use of Prague C and M criteria to record ESEM yielded a histological verification of BE rate of 67.7%. A standardized random quadruple biopsy to validate BE should be routinely performed. LS metaplasia was a single predictor of BE with borderline significance and male sex was a significant predictor of BE.
Aims: To compare blood loss following vaginal delivery by two different methods: visually estimated blood loss (vEBL) and calculated estimate of blood loss (cEBL).
Study Design: Postpartum blood loss was analyzed during 2 different time frames: 1. Traditional estimation (vEBL) of blood loss and 2. Following training, with the use of a systematic method (cEBL).
Place and Duration of Study: Department of Labor and Delivery at Maricopa Medical Center in Phoenix, Arizona. Charts were reviewed from September and October 2009 and from September 2010.
Methodology: This was a retrospective cohort study in which blood loss was compared using two different methods. Traditional physician estimate of blood loss at vaginal delivery, “vEBL” was compared to a more formal determination of blood loss “cEBL” - calculated blood loss.
Results: The cEBL subjects (mean age 28.0+/-6.6) were significantly older than the vEBL subjects (mean age 25.4+/-5.8). The two groups were otherwise similar. Mean blood loss was compared across the two methods using Analysis of Variance. Mean blood loss was 324 for the cEBL group, and 309 for the vEBL group (F(1,192)=0.76, p=.385). Although the difference in mean blood loss was not statistically significant, the variance of the cEBL method was significantly larger (P<.0005). 2/94 (2.1%) of patients in the vEBL group were noted to have blood loss ≥500cc; 11/100 (11%) of patients in the cEBL group were noted to have blood loss ≥500cc.
Conclusion: The variance for the cEBL method was significantly greater than in the vEBL group, suggesting that postpartum hemorrhage may be diagnosed sooner with this method. As calculation of blood loss postpartum is increasingly endorsed we recommend further study to determine the typical range for blood loss with measurement via this technique.
Aim: To determine the normal and extremes of values for interpupillary distance [IPD] amongst adults in Ogun State, South Western Nigeria.
Methodology: A population based cross-sectional study. Multi-staged stratified random sampling was used to select respondents from seven Local government areas in Ogun State.
Results: One thousand two hundred and seventy four respondents were examined and each had Interpupillary distance measurements done using an automated refractor. The mean age of the study population was 41.18±20.12 years with 57.4% females. The mean IPD was 67.50±4.06 mm with a minimum value of 50mm and maximum of 84 mm. Most [75.51%] of the respondents had IPD measurements within the range of 65 mm to 74 mm. The mean IPD for males was 68.76±3.89 mm while females were 66.58±3.94 mm.
Conclusion: The mean IPD and its upper limit obtained in this study were higher than previously documented by other studies. Inter pupillary distance increased with age and was higher in males.
The ultimate goal of the treatment of wounds is to restore the damaged skin both structurally and functionally to its original state. Conventional treatment of chronic wounds does not seem to work in several cases, so it is necessary to develop different strategies. Recent research advances have shown the great potential of cell-based therapies in improving the pace and quality of wound healing and skin regeneration. Cell-based therapy is thus considered a new alternative to classic methods of wound healing. This review seeks to give an updated overview of the applications of cell-based therapy in wound management. Even though cell therapy is a relatively new tool, several studies prove these types of cells can be used safely, and they have demonstrated their efficacy in healing wounds in several cases.