Bee stings can cause mortal anaphylactic reactions, which are also precursors to some other mortal events. Kounis syndrome (KS), or allergic myocardial infarctions, are well known concomitant events with every type of allergic reaction. KS should be considered in all patients with allergic events and concomitant chest pain admitted to emergency rooms. The clinical symptoms may not always be clear in these cases. The symptom of chest pain may not be seen in some mono- and poli-neuropathic conditions, particularly in diabetes, transplantation and drug user patients. We present a patient with KS secondary to bee sting.
Thiago Andrade Macedo, Antonio Claudio do Amaral Baruzzi, Pedro Gabriel de Melo Barros e Silva, Fabio Quartieri Alves, Renata Lopes Hames, Marcio Campos Sampaio, Jose Carlos Teixeira Garcia, Valter Furlan
Aims: In patients with infective endocarditis, with risk of embolization, early identification of parenchymal changes may suggest the risk of splenic rupture.
Presentation of Case: A 68-year-old male presented with a history of 2 months of fever and also left upper quadrant pain initiated 2 days before admission. Transesophageal echocardiogram demonstrated the presence of two mobile vegetations on the ventricular side of the aortic valve; the largest diameter being 2.1 cm. Enterococcus faecalis was isolated in blood culture after a diagnosis of subacute aortic valve infective endocarditis. He complained of abdominal pain. An abdominal computed tomography scan revealed infarction of the upper region of the spleen (septic embolism). Therapy with penicillin and gentamicin was initiated, but the patient developed symptoms of heart failure that led to a surgical treatment, and aortic bioprosthesis was implanted on day 14. On day 5 postoperatively, the patient developed sudden hemorrhagic shock signs due to splenic rupture and underwent emergency splenectomy. A pathological examination revealed areas of splenic laceration of the capsule, splenic infarction areas, and the absence of abscesses. Splenic rupture is a complication much rarely occurring due to infectious endocarditis caused by E. faecalis.
Conclusion: This case highlights the importance of conducting serial imaging, particularly in symptomatic patients, for the early detection of parenchymal changes that may suggest the risk of rupture.
Aims: The aim of this study was to determine the impact of religious practices and diet doctrines on obesity and hypertension among Pentecostal and orthodox Christians in the Tamale metropolis.
Study Design: This study was a cross sectional study.
Place and Duration of Study: This study was conducted between January and June 2014, at the Tamale metropolis, Ghana.
Methodology: Three hundred (300) Ghanaian subjects (50.3% Pentecostal participants from the Perez Chapel International and the Church of Pentecost and 49.7% Orthodox participants from the Presbyterian Church and Bethel Methodist Church), 18-72 years of age were recruited for this study. Anthropometric measurements including height, weight, waist and hip circumference as well as blood pressure were measured for each of the study participants.
Results: The male participants were taller, heavier with higher mean WHR as well as higher mean SBP as compared to the female participants. The females however, had broader hips as compared to the male participants. The males were more likely to fully comply with the religious prescription on fasting (52.6% vs. 40.7%; p = 0.0397) and diet (30.8% vs. 20.4%; p = 0.0375) as compared to the female. The prevalence of obesity among the population in this study ranged from 17% to 28% depending on the criteria used in the weight classification (i.e. BMI, WHR and WC) and the prevalence of hypertension was 15.0% with no significant difference between both genders.
Conclusion: This study highlights the significant increase in the prevalence of obesity and hypertension among both males and female populations, with obesity being more prevalent among females. Compliance to religious doctrines on fasting and or diet does not have an impact on the prevalence of obesity and hypertension from this study.
Introduction: In Africa, Nigeria has been reported as the largest destination for unregulated volume of electronic waste (e-waste). Currently, e-waste management practices in Nigeria remain completely primitive, taking place essentially in the informal sector. Recent report indicates that the majority (88.8%) of Nigerian e-waste workers have exposure burden of ≥6 hours per day; ≥6 days per week, and reportedly worked without personal protective devices. These crude management practices enhance the workers’ exposure to electronic waste borne toxic and carcinogenic metals and chemicals through almost all body cavities.
Objective: Concisely, this study aimed at evaluating the status of enzymatic and non-enzymatic oxidative stress biomarkers as cancer risk indices in Nigerians occupationally exposed to e-waste.
Methods: Serum levels of malondialdehyde (MDA), uric acid (UA), albumin (ALB), total bilirubin (TBil) and conjugated bilirubin (Cbil.)] and activities of enzymatic antioxidants [glutathione reductase (Gr), catalase (Cat), superoxide dismutase (SOD) and glutathione peroxidase (GPx)] were determined in Nigerian e-waste workers (n=63) and in age-matched unexposed participants (n=41), using standard colorimetric methods.
Results: Significantly elevated lipid peroxidation and raised uric acid levels were indicated in e-waste workers. Further to this, CAT, SOD and GPx were significantly reduced in e-waste workers compared with the unexposed human population. Comparatively different observations were not registered in the activity of GR and levels of ALB, TBil. and CBil. between exposed and unexposed participants.
Conclusion: This study provides evidence that the oxidative stress observed in the studied population could be associated with occupational exposure to e-waste chemicals and may be a predictive mechanism for chemical carcinogenesis in Nigerians involved in primitive e-waste management.
Background: Dentist and allied professionals are undoubtedly among professional groups at risk of noise- induced hearing impairment in the workplace. There has been speculation about the relationship between hearing loss and the use of high-speed dental drills among dental professionals. In resource-poor settings, dental instruments may be old and worn out with the attendant risks of hearing impairment following their use.
Aim: To report the awareness and assessment of work-related hearing impairment among dental professionals in Kano State.
Methods: The study was a cross-sectional self-administered questionnaire-based survey among Dentists and dental allied staff in Kano State. Participants were given questionnaires containing detailed information about the survey to fill after consenting. Each questionnaire was examined to ensure they were properly filled and the consent form duly signed.
Results: A total of 138 respondents fulfilled the inclusion criteria with a response rate of 86%. The highest respondents were Dental surgeon assistants and dental hygienist under 35 years (85.5%) of age and had worked for at least 5years. Sixty two respondents (44.9%) worked more than 8 hours / day while 76(55.1%) worked less than 8hours/day. Out of 99(71.7%) respondents who use Ultrasonic scaler about 43(43.0%) reported that the Ultrasonic scaler was at least 5 years old while out of 84 respondents who use dental turbines, 36(42.9%) of them reported that the turbines were at least 5years old. Loud power generators were an additional source of exposure to loud noise 42(31.6%) contributing to hearing impairment.
Conclusion: It is recommended that periodic hearing evaluation and use of hearing protective devices and appropriate content workshops/seminar about work related noise exposure made a mandatory part of continuous professional development for dental professionals.
Aim: To highlight the possibilities of Doppler methods to optimize navigation and control of percutaneous echo-controlled minimally invasive interventions.
Study Design: 25,543 diagnostic and therapeutic minimally invasive interventions were carried out on organs and tissues of different localizations.
Place and Duration of Study: Department of Oncology and Radiology, M. Gorky Donetsk National Medical University, Ukraine. 25,543 diagnostic and therapeutic minimally invasive interventions (2004-2013).
Methodology: Ten years of experience in carrying out percutaneous minimally invasive interventions under ultrasound guidance using Doppler modes. Fine needle aspiration and core needle biopsy, drainage, etc of different organs and tissues, effectiveness of optimization methods of visualization and analysis of results of their use in minimally invasive treatment of liver abscesses under US control, comparative analysis of main and control groups were carried out using student t-test and chi square - χ2. Ultrasound scanners used: Dornier AI 5200, Philips HDI 5000, Toshiba Aplio 500), probes - linear (7.5 MHz), convex (3.5-5.0 MHz). Paramount was the safety of minimally invasive procedure in visualizing instrument used.
Results: It was established that optimal was the power Doppler mode for navigation in percutaneous interventions, prevent hemorrhagic complications, select a safe acoustic window, which improved the location of fluid motion in the hollow needle and visualization of the biopsy instrument based on initiation of twinkling artifact. The use of developed methods to improve ultrasound visualization in minimally invasive treatment of liver abscesses significantly reduced pain - 12.9%, avoided haemorrhage and leakage of pus into peritoneal cavity, reduced the number of inadequate drainages - 36.6%, reduced the duration of inpatient treatment - 2.2 times.
Conclusion: It was established that use of power Doppler mode enhances the effectiveness and safety of percutaneous ultrasound-guided interventions. Thus, the studies confirmed the clinical use of optimization techniques of visualization in minimally invasive procedures under ultrasound guidance.
Aims: To study the correlation between the vascular endothelial growth factor A/VEGF-A level and the incidence of brain edema in acute ischemic stroke patients.
Study Design: A prospective observational analytic case-control study.
Place and Duration of Study: Stroke Unit at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia, between December 2010 and August 2011.
Methodology: Seventy-one hospitalized acute ischemic stroke patients were recruited, consisting of 37 subjects in the brain edema group and 34 subjects in the non-brain edema group. Comparative analysis of the VEGF-A levels in blood was performed between the brain edema and non-brain edema groups.
Results: The average level of VEGF-A in the brain edema group was 436 pg/mL and the one in the non-brain edema group was 746 pg/mL. This difference was statistically significant (95%CI: 5.5-615; P=.046). The proportion of VEGF-A levels less than the calculated cut-off point (638.3 pg/mL) in the brain edema group were significantly greater than the ones in the non-brain edema (83.78% and 58.82%, respectively; OR=3.6; 95%CI=1.06-13.26; P=.020).
Conclusions: The decreased levels of VEGF-A in blood were correlated with the incidence of brain edema in acute ischemic stroke patients.
In this pilot, sham controlled randomized control trial (RCT) in patients with ischemic central retinal vein occlusion (CRVO), we studied the safety and efficacy of intravitreal injection of autologous bone marrow derived mononuclear cells and found that both patients who received stem cell injections did not develop anterior segment neovascularization at 1 year follow up. Except for some sterile inflammatory reaction in the initial follow up, no long term injection related serious adverse events (SAEs) were observed. Based on our observations we recommend a larger, multicentric study to further establish the safety and efficacy of this treatment in patients with ischemic CRVO.
Purpose: To study the safety and efficacy of autologous bone marrow derived mononuclear cells injected intravitreally in patients with ischemic CRVO.
Study Design: Randomized sham controlled trial.
Methods: 4 cases with ischemic CRVO were recruited into the study. 2 cases were randomized into intervention group and 2 into control group. Baseline investigations included best corrected visual acuity (BCVA), intra ocular pressure (IOP), fundus fluorescein angiography (FFA), gonioscopy and optical coherence tomography (OCT). Patients in the intervention group received intravitreal injection of autologous bone marrow derived mononuclear cells (MNCs) and those in control group received sham injection. Patients were followed up over a 12-month period.
Main Outcome Measures: Development of anterior segment neovascularization.
Results: Both patients in the intervention group did not develop anterior segment neovascularization over a follow up period of 12 months. 1 patient in control group developed neovascularization of iris and elevated intra ocular pressure over a follow up period of 6 weeks and required trabeculectomy for control of IOP. The other patient in control group was lost follow up after 2 weeks.
Conclusions: Our initial observations suggest that intravitreal injection of mononuclear cells may reduce the risk of developing anterior segment neovascularization in patients with ischemic central retinal vein occlusion. A larger, multicentric study would be valuable to gain further evidence to our preliminary observations.
Aim: The benefits of prosthetic material in hiatal hernia repair have been well documented. However, the associated risks are substantial and they are related to the technique, and also the choice of material. Experimental data are invaluable to understand and evaluate the interaction of different meshes with the host tissue. The purpose of this article is to summarize the available experimental evidence in the repair of hiatal hernias with the use of prosthetic materials in animal models.
Methods: A review of the literature from January 1990 to December 2014 was carried out for articles presenting experimental data on hiatal hernia repair.
Results: After discarding non relevant articles, 28 articles were identified. A variety of synthetic and absorbable materials were studied. Review of the available studies showed that there is great variability between synthetic materials regarding tissue integration, shrinkage and adhesion formation, however they have greater mechanical strength when compared to biological/absorbable materials, which have a tendency to better integration. Biological adhesives seem to be an effective alternative method of mesh fixation.
Conclusions: Experimental data are essential in order to fully appreciate the process of repair of a hiatal hernia with a prosthetic material. The articles reviewed provide insight into the properties of different prosthetic materials. However, there were large variations in their quality and the methods used. Data from animal studies are an excellent way of evaluating the multitude of materials that have recently become available. Good quality, comparative animal studies are essential in an effort to further improve outcomes for patients who undergo hiatal hernia repair.
Background: A critical step in periodontal regenerative therapy is to alter the periodontitis affected root surface to make it a hospitable substrate, to support and encourage migration, attachment, proliferation and proper phenotypic expression of periodontal connective tissue progenitor cells. So the Concept of Biochemical modification or alteration of the root surface has emerged as a potential therapeutic approach to the reconstruction of the periodontal unit.
Aim: To review various agents used for root biomodification and update on the current status of root biomodification in periodontal regenerative therapy.
Materials and Methods: Google Scholar database is searched using keyword “Root Biomodfication”and the studies with experimental design either In Vivo or In vitro were included in the search whereas Narrative reviews or Non – Systematic reviews were excluded. These studies were reviewed together to update the various agents used for root biomodification and their current status in Periodontal regenerative therapy.
Result: Only the representative studies of the agents used were included in this studies including 2 systematic review, 1 literature review and 1 world workshop report.
Conclusion: The present status suggests that root biomodification does not have any added advantage in periodontal regeneration. Large Size randomized clinical trials are necessary to give an definite conclusion.